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Investigating the Impact of the Amount of Contrast Material Used in Abdominal CT Examinations Regarding the Diagnosis of Appendicolith

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E Lavdas

E Lavdas1*, N Boci2 , L Sarantaenna2 , A Godevenos2 , I Ntavelis2 , T Theodoropoulos2 , G Zaimis1 , P Mavroidis3 , (1) Technological Education Institute of Athens, Athens, Attica, (2) Animus kyanoys Larisas Hospital, Larissa, Thessaly, (3) University North Carolina, Chapel Hill, NC


SU-F-I-29 (Sunday, July 31, 2016) 3:00 PM - 6:00 PM Room: Exhibit Hall

Purpose: The purpose of this study is to report the case of a young adult in which the incomplete oral administration of contrast material led to diagnosis of an appendicolith, which cause acute appendicitis.

Methods: A male 34 years old underwent CT examination due to acute abdominal pain in the upper abdomen. An ultrasound examination of the upper abdomen and kidneys, an x-ray examination of the abdomen and a CT scan of the entire abdomen and pelvis after both oral and IV administration of contrast material were performed. In the ultrasound examination, both kidneys gallbladder and spleen appeared normal and the x-ray examination did not show any pathological findings. As part of the CT examination, the patient received oral contrast material less than 500 ml due to lack of cooperation by the patient as a result of his abdominal pain.

Results: The CT abdomen revealed a severely inflamed appendix that was significantly dilated at 1.1 cm. Moreover, it demonstrated a 1.4 cm appendicolith. The portion of the oral contrast material that was injected to the patient covered the upper abdomen and as a result an appendicolith could be revealed in the lower abdomen. If the patient had received the 1,000ml of contrast material, the whole abdomen would have been covered with the contrast in danger to lose the appendicolith, which caused the inflammation.

Conclusion: Based on the findings of this study, in suspicion of acute appendicitis nephrolithiasis and ureterolithiasis, we propose to start the CT protocol with a CT scan without oral contrast material and then proceed with oral and IV contrast not only to succeed gastric intestinal differentiation but also to avoid covering the lower abdomen and obscure any small stones that may exist.

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