Inflammation of Vermiform Appendix Guidelines

Updated: Sep 30, 2019
  • Author: Steven L Lee, MD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Guidelines

ACR Appropriateness Criteria for Imaging in RLQ Pain/Suspected Appendicitis

In 2018, the American College of Radiology (ACR) issued revised recommendations for imaging in patients with right-lower-quadrant (RLQ) pain and suspected appendicitis. [18]

For patients with RLQ pain, fever, leukocytosis, and suspected appendicitis, initial imaging recommendations include the following:

  • Usually appropriate - Computed tomography (CT) of abdomen and pelvis with intravenous (IV) contrast
  • May be appropriate - CT of abdomen and pelvis without IV contrast; ultrasonography (US) of abdomen; magnetic resonance imaging (MRI) of abdomen and pelvis without and with IV contrast; US of pelvis; MRI of abdomen and pelvis without IV contrast 
  • Usually not appropriate - CT of abdomen and pelvis without and with IV contrast; radiography of abdomen; fluoroscopy contrast enema; technetium 99m (Tc-99m) white blood cell (WBC) scan of abdomen and pelvis 

For patients with RLQ pain, fever, leukocytosis, possible appendicitis, and an atypical presentation, initial imaging recommendations include the following:

  • Usually appropriate - CT of abdomen and pelvis with IV contrast
  • May be appropriate - CT of abdomen and pelvis without IV contrast; US of abdomen; MRI of abdomen and pelvis without and with IV contrast; US of pelvis; MRI of abdomen and pelvis without IV contrast 
  • Usually not appropriate - CT of abdomen and pelvis without and with IV contrast; radiography of abdomen; fluoroscopy contrast enema; Tc-99m WBC scan of abdomen and pelvis

 For pregnant women with RLQ pain, fever, leukocytosis, and suspected appendicitis, initial imaging recommendations include the following:

  • Usually appropriate - US of abdomen; MRI of abdomen and pelvis without IV contrast
  • May be appropriate - US of pelvis; CT of abdomen and pelvis with IV contrast; CT of abdomen and pelvis without IV contrast
  • Usually not appropriate - MRI of abdomen and pelvis without and with IV contrast; CT of abdomen and pelvis without and with IV contrast; radiography of abdomen; Tc-99m WBC scan of abdomen and pelvis; fluoroscopy contrast enema