Appendix cancer CT scan

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]


Abdominal CT scan is helpful in the diagnosis and management of appendix cancer. Findings on CT scan suggestive of appendix cancer include soft tissue thickening, wall irregularity, calcification, internal septations, preappendiceal fat stranding as well as intraperitoneal free fluid. CT scan is also one of the best imaging modalities to assess disease burden, metastatic lesions as well as disease stage.

CT scan

Appendiceal adenocarcinoma complicated by retroperitoneal abscess. Case courtesy of Dr Francis Fortin,, rID: 58007
Appendiceal adenocarcinoma complicated by retroperitoneal abscess: Please note to the suspected appendiceal tip tumor (red) communicating with the retroperitoneal abscess (yellow). Case courtesy of Dr Francis Fortin, <a href=""></a>. From the case <a href="">rID: 58007</a>

Peritoneal carcinomatosis index

  • Peritoneal carcinomatosis index (PCI): A widely accepted metric for assessment of disease border in appendix cancer:[2]
  • Table and figure below demonstrate abdominal regions as well as scoring system for PCI.
Peritoneal Carcinomatosis Index (PCI) Regions
PCI Scoring System
Lesion Size Score
LS0 No tumor seen
LS1 Tumor up to 0.5 cm
LS2 Tumor up to 5 cm cm
LS3 Tumor > 5 cm or confluence
Maximum Score = 3
Regions (0-3)
0 Central
1 Right Upper
2 Epigasterium
3 Left Upper
4 Left Flank
5 Left Lower
6 Pelvis
7 Right Upper
8 Right Flank
9 Upper Jejunum
10 Lower Jejunum
11 Upper Illeum
12 lower Illeum
Maximum Score = 36
Total Maximum Score = 39
Liver metastases from gastrointestinal carcinoid. Case courtesy of Dr Natalie Yang, <a <nowiki>&lt;nowiki&gt;&amp;lt;nowiki&amp;gt;&amp;amp;lt;nowiki&amp;amp;gt;&amp;amp;amp;lt;nowiki&amp;amp;amp;gt;&amp;amp;amp;amp;lt;nowiki&amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;lt;nowiki&amp;amp;amp;amp;amp;gt; &amp;amp;amp;amp;amp;lt;/nowiki&amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;lt;/nowiki&amp;amp;amp;amp;gt;&amp;amp;amp;lt;/nowiki&amp;amp;amp;gt;&amp;amp;lt;/nowiki&amp;amp;gt;&amp;lt;/nowiki&amp;gt;&lt;/nowiki&gt;</nowiki>ref="<nowiki>&lt;nowiki&gt;&amp;lt;nowiki&amp;gt;&amp;amp;lt;nowiki&amp;amp;gt;&amp;amp;amp;lt;nowiki&amp;amp;amp;gt;&amp;amp;amp;amp;lt;nowiki&amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;lt;nowiki&amp;amp;amp;amp;amp;gt;;amp;amp;amp;amp;lt;/nowiki&amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;lt;/nowiki&amp;amp;amp;amp;gt;&amp;amp;amp;lt;/nowiki&amp;amp;amp;gt;&amp;amp;lt;/nowiki&amp;amp;gt;&amp;lt;/nowiki&amp;gt;&lt;/nowiki&gt;</nowiki>"></a>. From the case <a href="">rID: 7010</a>
  • Low attenuated, well defined mass in right lower quadrant, near cecum without inflammation points to appendiceal mucocele.


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