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Early appendicitis in a 30-year-old woman with twins of 28 weeks gestational age who presented with right upper quadrant pain. She underwent an initial CT examination due to technical inability to perform an MR imaging examination. CT was performed without intravenous contrast material and limited to the area of pain to reduce the amount of radiation to the fetuses. (a, b) Axial (a) and coronal reformatted (b) unenhanced CT images show a nondistended appendix (arrows) next to the gravid uterus. The results were interpreted as negative for appendicitis because of the size of the appendix (<6 mm) and lack of periappendiceal inflammation. After resolution of the technical issues, MR imaging was performed 2 hours after the initial CT because of continued clinical concern despite the negative CT results. (c, d) Axial (c) and coronal (d) T2-weighted single-shot fast SE images obtained at the same level show a fluid-filled thick-walled appendix (arrow) that is normal in size (<6 mm in diameter). Periappendiceal inflammation was absent at fat-saturated imaging. The MR images were interpreted as consistent with early appendicitis, which was confirmed at laparotomy and pathologic analysis.
