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Age: 13

Sex: Male

Indication: Lower abdominal pain

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Case #21


Findings

  • Calcific density projects over the right iliac bone on both views
  • Nonobstructive bowel gas pattern
  • No abnormal intraabdominal mass effect


Diagnosis

  • Acute appendicitis

Sample Report

Calcific density projects over the right iliac bone on both views, which may represent an appendicolith or calcification within the fecal stream. Consider ultrasound for further evaluation if there is clinical concern for acute appendicitis.

Nonobstructive bowel gas pattern.

No abnormal intraabdominal mass effect.


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, though its utility decreases in obese children


Images

Red arrow: calcific density overlying the right iliac bone, which may represent an appendicolith.

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