Fig. 4. A 40-year-old male who presented with a 24-hours history of abdominal pain, which was more marked in the right lower quadrant.

A, B. Dual-energy CT (A) source sagittal image shows dilated retrocecal appendix with mural thickening, surrounding inflammatory fat stranding (curved arrow), thickening of peritoneal reflections (notched arrow) and trace free fluid consistent with acute appendicitis. A 5-mm hyperdense appendicolith (arrow) in the mid appendix. (B) Color coded iodine maps reveals an area of reduced iodine uptake along the posterior wall of the appendicular tip with reduced iodine uptake (arrow), concerning for early gangrenous appendicitis with histopathologic confirmation of acute appendicitis with mural necrosis.