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Case of the Month

May 2014

Patient Data: 29 year old female (the same patient as in the case of the month august 2005

Clinical Info: Patient was admitted to the hospital with pain in the right upper abdomen. There are raised infection parameters. The referring physician wanted us to confirm a cholecystitis. However because she had had an operation for her choledochal cyst we presumed the gallbladder was also removed


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Abnormal tubular structure anterior of the right liver lobe


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In the other direction the structure is rounded


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Another image of the tubular structure anterior of the liver. Does this look like a cholecystitis?


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A larger image of the tubular structure


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The structure is rounded. What would be your diagnosis if the structure was in the right lower abdomen


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There is an appendiculith in the structure


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There is some increased vascularity of the wall


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53430-20130614001_20130614101901.swf The patient indeed had undergone a cholecystectomy. She did not have a cholecystitis but an appendicitis that was positioned in the upper abdomen anterior of the liver. The patient was operated and the diagnosis was confirmed.


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This is another case of an appendicitis anterior inferior of the liver in a young patient who had delivered a baby just a few days prior to the ultrasound examination. The appendix is perforated with a small effusion at the tip


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transverse image of the inflamed appendix


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A few days later she sill has pain and a control examination shows a small effusion at the lower part of the liver. Do you think this is the problem?


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There is a dilatated right kidney do you think this is the result of the previous pregnancy?


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The left kidney is not dilatated


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The right ureter is dilatated and ends in a small ureteric stone


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X ray of the ureteric stone

Always remember an appendix is commonly but not always positioned in the right lower abdomen. An ectopic lying inflamed appendix can cause clinical confusing symptoms.
Also remember that in incidental cases there can be more than one problem.

For more examples of appendicitis see

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