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Giant Mucocele of the Appendix

Clinical and Imaging Findings in 3 Cases

Unità Operativa di Ecografia ed Ecointerventistica (G.F., F.S., F.D.M.), Dipartimento di Diagnostica per Immagini (G.L., V.M.), and Dipartimento di Chirurgia Generale (C.G., G.A.), Presidio Ospedaliero Camilliani S. Maria Della Pietà, Casoria, Italy.

Address correspondence to Giampiero Francica, MD, Unità Operativa di Ecografia ed Ecointerventistica, Presidio Ospedaliero Camilliani S. Maria Della Pietà, Via S. Rocco 9, 80026 Casoria (NA), Italy. E-mail: giampierofrancica{at}tin.it

Objective. Clinical and imaging (sonographic and computed tomographic [CT]) findings in 3 cases of giant mucocele of the appendix are described. Methods. Clinical records of 3 cases of giant mucocele of the appendix were reviewed. All patients had a basal B-mode sonographic examination and a contrast-enhanced sonographic examination using a second-generation low–mechanical index contrast medium. In all cases, a dual-phase spiral CT examination was carried out. Results. In 2 cases, the abdominal masses were discovered in asymptomatic patients; 1 patient had vague abdominal discomfort. A pathologic diagnosis of benign cystoadenoma was found at pathologic examination in all cases, and malignant pseudomyxoma peritonei was disclosed in 1 patient 1 year later. Common sonographic findings were as follows: (1) a huge abdominal mass with a maximum diameter ranging between 20 and 25 cm; (2) a thin hyperechoic border without either solid vegetations or signs of infiltration of surrounding tissues; (3) a complex internal echo structure with anechoic lacunae interspersed between curvilinear, wavy bands of echogenic material (the so-called sonographic onion skin sign); and (4) avascularity of the masses shown on contrast-enhanced sonography with a low–mechanical index medium. At CT, a well-circumscribed cysticlike mass of low attenuation was displayed in all cases. There was lack of enhancement during a dual-phase examination in 2 cases; in the other, a small peripheral area of faint enhancement was appreciated. Only in the latter case could CT reliably assess the origin of the mass. Conclusions. It is suggested that a combination of sonographic (namely the onion skin sign) and CT findings may aid in the correct preoperative diagnosis of giant mucocele of the appendix.

Key Words: appendix • computed tomography • mucocele • sonography

Abbreviations: CT, computed tomography

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