Multidetector CT findings of neurogenic appendicopathy

Abstract

Neurogenic appendicopathy is a condition in which abnormalities within the appendix produce symptoms that mimic acute appendicitis. It is usually difficult to differentiate between neurogenic appendicopathy and acute appendicitis from their clinical history, symptoms, laboratory findings and physical examination. We experienced two cases of neurogenic appendicopathy diagnosed from histopathologic findings, in which patients had presented with right lower abdominal pain. On Multidetector Computed Tomography, dilated appendix was depicted with uniform enhancement, associated with calcifications (or appendicolith). Inflammatory change was not so remarkable in both cases. We suspected appendiceal tumor from imaging findings in both cases and elective surgeries were performed. Pathologically, neuroma-like proliferation of nerve fibers was found, which were stained with S-100 protein in submucosal layer. The imaging features of neurogenic appendicopathy, including Computed Tomography, have not been reported in English literatures. In this article, we reported the imaging characteristics on Multidetector Computed Tomography in these two cases of neurogenic appendicopathy, correlated them with pathologic features. It is supposed to reflect its pathological change including edematous change, proliferation of collagen and nerve fibers. There has been no definitive criterion for imaging diagnosis of neurogenic appendicopathy, and further investigation is needed to evaluate for the imaging characteristics and its significance in clinical situation.