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Case of the Month

August 2015

Patient Data: 13 year old boy

Clinical Info: Admitted to the hospital with clinical signs of an appendicitis

There is an oval structure with signs of inflammation

There are a few airbubbles

The wall of the lesion is vascularized

This is the longitudinal image of the same structure. There is also a small lymph node

Another image of the structure. Is this the appendix?

The fat surrounding the structure is inflamed

The terminal ileum is normal

This is the transverse image of the appendix which is normal

This the longitudinal image of the appendix which again is normal

This is the tip of the long appendix. So an appendicitis was excluded.

This is another case of a middle aged man with the same symptoms. The cecal wall is thickened

The problem seems to lie next to the cecum

The illeal wall is slightly thickened

There is increased vascularity consistent with inflammation.

This is a transverse view of what looks like an inflamed appendix. No normal appendix could be found. A CT scan was performed

62116-Mijn_Film_1.swf CT

62117-Mijn_Film_2.swf CT

62118-Mijn_Film_3.swf CT

In the first case, because there were signs of an inflammation in the right lower abdomen the surgeon decided to operate although the radiologist advised to do an MRI or a CT scan because he thought it was a cecal or right sided diverticulitis and not an appendicitis At operation it proved not to be an appendicitis but a cecal diverticulitis.
The second patient did have an appendicitis with a cecitis The appendix was short and had perforated.
Not everery inflammation in the right lower abdomen is an appendicitis. Beware of other pathology. If the surgeon had believed the radiologist or had requested an adjuvant CT scan or MRI the first patient would possibly not have been operated

For more cases of right sided diverticulitis and appendicitis see

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