Presentation
Lower abdominal pain, mainly in the right lower quadrant, nausea, vomiting, and fever. Lab tests revealed elevated white blood cell (WBC) and C-reactive protein (CRP) levels.
Patient Data
The mid-portion of the appendix is obstructed by a large appendicolith, causing distal dilatation with subtle adjacent fat stranding and prominent adjacent lymph nodes. Multiple luminal appendicoliths are noted at its tip.
The proximal appendix is normal in caliber.
Case Discussion
In acute appendicitis, usually the entire length of the appendix is affected; however, not uncommonly, the inflammation may involve just the tip or midway (as in this case).
The proximal appendix was challenging to find. However, with careful observation and with the help of ultrasound (images not shown), the patient was diagnosed with acute appendicitis and subsequently underwent surgery, which confirmed the diagnosis.
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