What is the preferred initial imaging modality for suspected appendicitis in adults?

• A. MRI abdomen
• B. X-ray abdomen
• C. Ultrasound abdomen
• D. CT abdomen/pelvis with contrast

Answer: (D)

In adults with suspected appendicitis, you want imaging that reliably confirms inflammation and also reveals other possible causes of pain. CT of the abdomen and pelvis with IV contrast provides the highest diagnostic accuracy, quickly showing an enlarged, inflamed appendix and periappendiceal fat stranding, as well as other signs like an appendicolith or perforation. It also helps distinguish appendicitis from other conditions that mimic it, guiding urgent surgical vs medical management.

Ultrasound can be helpful, especially in young patients, pregnant patients, or when minimizing radiation is important, but its accuracy is more variable because it depends on the technician and body habitus and can miss cases in obese individuals or with retrocecal appendix. X-ray has limited utility for appendicitis. MRI is accurate and radiation-free but is less practical as a first-line test in many settings due to availability, cost, and time.

So CT abdomen/pelvis with contrast is the best initial imaging choice in the typical adult presenting with suspected appendicitis.