Figure 1
Multislice CT findings
Axial image, multislice spiral CT: evidence of a cystic formation in the appendix region. There is a clear cleavage plane between the calcified walls of the cyst and the iliac artery.
Mucocoele: multislice CT findings
SectionAbdominal imaging
Case TypeClinical Cases
AuthorsM. Danti, R.Ferrari, P.Paolantonio,A.Righi , V.Panebianco
Connected authors
78 years, male
Clinical History
A 78-year-old man presented with right lower quadrant abdominal pain and bile emesis. An abdominal X-ray demonstrated an ovular opacity with calcified walls.
Imaging Findings
A 78-year-old man presented with deteriorating health, abdominal pain and bile emesis. Objective examination demonstrated muscular resistance in the right lower quadrant and sharp pain on palpation. An abdominal X-ray was performed. It demonstrated an oval opacity with calcification of the walls. Differential diagnosis included iliac vessel aneurysm, large bowel diverticulum or mucocoele. For this reason an abdominal-pelvic CT was performed using spiral multidetector equipment
Discussion
Mucocoele is a rare lesion that is found in only 0.2-0.3% cases of appendectomy. The pathology is associated with dilation of the vermiform appendix by intraluminal accumulation of mucoid material; possible causes are non-neoplastic obstruction of the lumen or neoplastic obstruction due to mucosal secretion by mucinous appendicular cystoadenoma or cystoadenocarcinoma.
The diagnosis of mucocoele is frequently an incidental finding during examination for other pathology because of the aspecificity of its symptoms. Possible complications are rupture (causing pseudomyxoma peritonei), malignant trasformation, or obstruction caused by intussusception, so a precise diagnosis is required.
Abdominal X-ray and ultrasound studies do not seem to have sufficient diagnostic accuracy. Multidetector spiral CT without administration of intravenous contrast medium reveals the presence of an ovular lesion in the lower right part of the abdomen with densitometry characteristic of dense-fluid tissue and calcified walls. Continuity with the lumen of the caecum and a clear cleavage plane with the iliac vessels are well demonstrated by coronal 2D reconstruction. These findings exclude the presence of a diverticulum or iliac vessel aneurysm and confirm the diagnosis of a mucocoele.
Differential Diagnosis List
Mucocoele of the appendix
Final Diagnosis
Mucocoele of the appendix
References
[1]
Souei-Mhiri M, Tlili-Graies K, Ben Cherifa L, Derbel F, Hmissa S, Dahmen Y, Jeddi M.
Mucocele of the appendix. Retrospective study of 10 cases.
J Radiol. 2001 Apr;82(4):463-8. French. (PMID: 11353901)
[2]
Abdelouafi A, Essodegui F, Ousehal A, Kadiri R.
Appendiceal mucocele. Apropos of 6 cases.
Ann Radiol (Paris). 1996;39(3):119-25. French. (PMID: 9163962)
[3]
Zago A, Ferrara R, Fasoli G, Gandolfi P, Caudana R, di Benedetto P, Rosa G.
Appendicular mucocele. A report of a case diagnosed preoperatively.
Minerva Chir. 1994 Dec;49(12):1329-33. Review. Italian. (PMID: 7746457)
Case information
| URL: | https://eurorad.org/case/1228 |
| DOI: | 10.1594/EURORAD/CASE.1228 |
| ISSN: | 1563-4086 |
Figure 2
Coronal reconstruction in multislice CT findings
Coronal images, 2D reconstruction. The continuity of the cystic structure with the large bowel confirms the diagnosis of a mucocoele.
Multislice CT findings
Axial image, multislice spiral CT: evidence of a cystic formation in the appendix region. There is a clear cleavage plane between the calcified walls of the cyst and the iliac artery.
Coronal reconstruction in multislice CT findings
Coronal images, 2D reconstruction. The continuity of the cystic structure with the large bowel confirms the diagnosis of a mucocoele.