Appendiceal enlargement as a criterion for clinical diagnosis of acute appendicitis: is it reliable and valid?

Abstract 

The purpose of this study was to evaluate appendiceal enlargement as a radiographic criterion for the diagnosis of acute appendicitis. We examined medical records and specimens of 190 adults and children who presented to a teaching hospital in New York City with right-lower-quadrant pain and who underwent surgery. Computed tomography (CT), clinical evaluation (based on Alvarado’s predictive model) and pathologic data of these 190 cases revealed that appendiceal enlargement might in some cases represent a normal anatomic variant of a vermiform appendix and that the lack of a dilated lumen and thickened wall did not necessarily establish the absence of inflammation. Yet, radiologic evidence of appendix size often influences the diagnosis and management of patients with acute abdominal pain, including the decision to operate. This tendency to equate an enlarged appendix with appendicitis is shown to lead to an inappropriate diagnosis and jeopardize optimal care of patients with acute abdominal pain.

Keywords:  appendiceal enlargement, acute appendicitis, clinical data, Alvarado’s predictive model, histologic findings, computed tomography, anatomic variant of a vermiform appendix