Presentation
Fall on lower back.
Patient Data
No fracture or luxation.
L4-L5 medial disc protrusion, exerting mild pressure on the thecal sac.
Subcecal vermiform appendix containing calcific material. Abutting the distal third of the appendix is a minuscule oval fat-density structure with a hyperdense central dot, surrounded by fat stranding.
Small umbilical hernia containing fat.
Case Discussion
The patient fell on his back and then began to complain that he could not bear his own weight. On examination in the orthopedic emergency department, tenderness was elicited over L4 and L5 spinous processes. A CT ruled out a spinal fracture. However, the CT did note a tiny fat-density structure contiguous with the appendix, which contained a central hyperdense dot and was surrounded by fat stranding. The radiologist called the referring orthopedic surgeon to ask the patient whether he suffered from abdominal pain, which the patient noted he has had right lower quadrant abdominal pain for several days. Thus rendering the diagnosis of an appendiceal epiploic appendagitis 1-3 quite probable.
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