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  • Title: Size matters: Computed tomographic measurements of the appendix in emergency department scans.
    Author: Moskowitz E, Khan AD, Cribari C, Schroeppel TJ.
    Journal: Am J Surg; 2019 Aug; 218(2):271-274. PubMed ID: 30558802.
    Abstract:
    BACKGROUND: Radiologists use a size cutoff in appendiceal diameter to assist surgeons in diagnosing appendicitis, however, no consensus exists as to the size of a normal adult appendix. We aim to evaluate radial appendiceal diameter on CT in adult patients both with and without appendicitis. METHODS: Retrospective review of adults who underwent abdominal CT was performed. Variables collected include: demographics, BMI, WBC count at presentation, radial diameter of appendix (mm), presence of fat stranding, fecalith, and free fluid. RESULTS: During the study period, 3099 patients underwent CT. The appendix was visualized on 74% of scans. Mean appendiceal diameter was 6.6 mm (±1.7). The appendix was larger in patients with appendicitis (6.6 vs. 11.4; p < 0.0001). Overall appendectomy incidence was 3.2%. Sensitivity and specificity of CT in diagnosing appendicitis in this cohort of patients were 90% and 94%. NPV was 99.5%. CONCLUSION: While appendiceal diameter was larger in patients with appendicitis, >20% of patients without appendicitis had an appendiceal diameter >7 mm. Diameter alone should not be relied upon to diagnose appendicitis.
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