Case 59

 A fifty two-year-old female came to our hospital for right lower abdominal pain. She ate baked chicken and salmon at 7PM yesterday. Abdominal pain emerged this early morning two hours before her coming. She looked pale and painful. Laboratory test revealed CRP 0.09 mg/dL, white blood cells 11600/mm³, neutrophils 58.7 %, procalcitonin 0.09 (ng/ mL < 0.12). Non-enhanced CT was conducted on Day 1 (Fig.1). She was admitted to get intravenous antibiotics for a few days. None the less, abdominal pain gradually worsened. McBurney tenderness was positive and Blumberg sign was negative. Laboratory test on Day 2 revealed CRP 23.3 mg/dL, white blood cells 20720/mm³, neutrophils 95.3% and contrast-enhanced CT was conducted (Fig.2). Despite continuous intravenous antibiotics, no improvement of symptoms was obtained. On Day 4, on-enhanced CT was added to check the size of the appendix, colon and small bowel (Fig. 3).

What is the imaging diagnosis based on non-enhanced CT of Day 1 and contrast-enhanced CT on Day 4 ?

a. Appendicitis

b. Infectious colitis

c. Infectious ileitis

d. Cecum infection

e. Cecum cancer

1. a, b, c 　　2. b, c, d 　　 3. c, d, e　　 4. all

answer

2017.6.21