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Case of the Month

April 2005

Patient Data: 15 year old boy

Clinical Info: Admission under suspicion of appendicitis but the boy is complaining about right lower quadrant pain for a longer time.


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Longitudinal image showing a massive thickened appendix with a fecolith at the tip.


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Transverse image showing the same massive thickened appendix.


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Transverse image with color doppler showing vascularization of the appendiceal wall.


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Longitudinal image with color doppler showing vascularization of the appendiceal wall.


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There is not only thickening of the appendix but also of the cecal wall.


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Longitudinal image of the thickened cecal wall with thumb printing. Because this was not a normal presentation of an acute appendicitis the patient was not operated, but instead a biopsy was performed which showed granulomas highly suggestive for Crohn´s disease. No signs of malignancy were found.


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In cases of acute appendicitis there can also sometimes be a massive thickened appendix as in this case.


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One should always remember that a thickened appendix does not always means that there is an acute appendicitis as in this case of non Hodgkin´s lymphoma.

For more images of acute appendicitis and diseases that mimic appendicitis see:

Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.

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