MediAI

Edited by ScholarGen MediAI Team Executive Answer Acute appendicitis is diagnosed on CT by integrating appendiceal enlargement with mural thickening, wall enhancement, and periappendiceal inflammatory change. In this adolescent female case, the appendix was markedly dilated to approximately 16 mm and demonstrated mural thickening, enhancement, extensive surrounding fat stranding, adjacent fluid, and a focal mural defect. The mural defect is particularly important because it raises concern for necrosis and microperforation, moving the interpretation beyond uncomplicated appendicitis. For radiologists, the key lesson is simple: do not stop after identifying an enlarged appendix. Evaluate the appendiceal wall, surrounding tissues, fluid, gas, and alternative diagnoses systematically. Why This Case Matters Acute abdominal pain in an adolescent can present a diagnostic challenge because several gastrointestinal, urinary, and gynecologic conditions can produce similar symptoms. When right lo...

Edited by ScholarGen MediAI Team Executive Answer An adrenal mass in a patient with known metastatic malignancy is not automatically an adrenal metastasis. In this case, a well-defined left adrenal mass measured approximately −59 HU on CT , strongly indicating macroscopic fat. MRI further demonstrated persistent high signal on in-phase and out-of-phase images with signal suppression on fat-suppressed sequences, supporting macroscopic rather than intracellular lipid. Diffusion-weighted imaging showed no definite restriction, and the lesion demonstrated no significant uptake on Cu-64 DOTATATE PET/CT. Taken together, these findings support adrenal myelolipoma , a benign fat-containing adrenal tumor, rather than metastatic neuroendocrine tumor. Why This Case Matters An adrenal mass can become diagnostically difficult when it appears in a patient who already has proven malignancy. The clinical context can create a powerful assumption: Known cancer + new adrenal mass = adrenal metastasis. Th...