Introduction: The appendix is identified as blind ending tubular structure arising from caecum and has variable intraluminal contents and position. Acute appendicitis is one of the common indications for emergency imaging studies. Aim: To describe the importance of appendix hyperattenuation and densities. Material and Methods: Contrast enhanced computed tomography images of abdomen from 120 patients with surgically/pathological proven acute appendicitis, were examined retrospectively. The images were reviewed in axial, coronal and sagittal reformations for assessing the intraluminal contents (hyperdensity and appendicolith), maximum transverse diameter and single wall thickness of appendix, periappendiceal fat stranding and other parameters related to acute appendicitis. In addition, reviewing 100 pre- and post-contrast CT scans of other abdominal conditions as a control group for documenting hyperdense appendix, appendicolith and other signs of appendicitis. Results: The hyperdense appendix sign was found in 5 patients in our study, not found in any patient of the control group (P value = 0.039, is statistically), appendicolith was found in 25% in patients with acute appendicitis, in 3% in control group (statistically significant, p < 0.0001). Conclusion: The hyperdense appendix and appendicolith have strong association with acute appendicitis in the appropriate clinical setting.
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