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Age: 2

Sex: Male

Indication: Abdominal pain

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Case #8


Findings

  • Nonobstructive bowel gas pattern
  • No abnormal intraabdominal mass effect
  • 3 mm calcification overlying the right iliac bone
  • Mild pulmonary hyperexpansion with diffuse peribronchial thickening


Diagnosis

  • Acute appendicitis

Sample Report

Nonobstructive bowel gas pattern.

No abnormal intraabdominal mass effect.

3 mm calcification overlying the right iliac bone, which could represent an appendicolith. Consider ultrasound for further evaluation if there is clinical concern for acute appendicitis.

Mild pulmonary hyperexpansion with diffuse peribronchial thickening, which may relate to viral bronchiolitis.


Discussion

  • Appendicoliths have a high specificity but low sensitivity for acute appendicitis
  • A calcification in this location on a radiograph could be in other places than the appendix, including the adjacent bowel, bone, or soft tissues, so the radiographic finding alone is highly nonspecific
  • Ultrasound is the best study to evaluate for acute appendicitis in young children


Images

Red arrow: calcification overlying the right iliac bone.

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