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Imaging investigation of acute right iliac fossa pain

Radiology, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK

• Appendicitis is a common condition for which imaging is being used both earlier and more frequently in the clinical assessment.
  
• Ultrasound examination avoids ionizing radiation and has a high positive predictive value. Its weakness is a low sensitivity and negative predictive value.
  
• CT can accurately diagnose appendicitis and often diagnose an alternative cause, should one exist.
  
• There are a number of different scanning regimens, utilizing either no contrast or a combination of oral, intravenous and rectal contrast. No one technique has proved consistently superior.
  

Acute right iliac fossa pain is a common clinical emergency that requires prompt investigation and diagnosis. Although acute appendicitis is the most common condition, there is a large differential diagnosis, and in up to one-third of cases the cause is not apparent. Diagnostic imaging is increasingly used and at an earlier time point. We shall review the clinical conditions that may cause acute right iliac fossa pain and their appearance with different imaging modalities.