Wednesday, 18 March 2015

xrayoftheweek 11: is this ultrasound abnormality significant?

 This week's #xrayoftheweek case is an ultrasound image to start with. This was seen in the right iliac fossa/right adnexa of a woman with vague abdominal pains. What could this be and what is it's significance?

(hint: previous salpingo-oopherectomy)

There is an elongated tubular structure measuring 7.7 cm in length. It is not entirely echo-free in the centre, with some mixed echogenicity material seen. There is no overt calcification. Given the history of previous salpingo-oophorectomy, this is unlikely to be fallopian tube in origin. This lesion has the appearances of an appendix mucocoele (mucocele for N American readers!).

The following is a coronal CT from the same person:

This confirms a tubular lesion arising from the caecal pole. There is minimal calcification seen at the caecal end of the lesion but no obstructing calcified appendicolith is seen. The diagnosis of appendiceal mucocoele is confirmed.

A mucocoele of the appendix refers to distension due to accumulation of mucinous material within the lumen, occurring due to obstruction of the lumen. Whilst hyperplasia of the mucosa is a cause, neoplastic (both benign and malignant) appendiceal neoplasms are also a cause. In these latter cases, if the appendix ruptures, pseudomyxoma peritonei is a concerning outcome.

(links to two articles as well as this case on Radiopaedia above)