Right iliac fossa pain and vomiting for 8 hours.
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Distended inflamed appendix (11 mm in diameter) with surrounding fat stranding.
Sub-centimetric prominent surrounding lymph nodes.
No abnormal collection or abscess formation.
No free air in the peritoneal cavity to suggest bowel perforation.
Unfortunately the radiologist failed to detect the inflamed appendix with ultra-sonography and the clinician then requested for CT.
CT has a high sensitivity and specificity in the detection of acute appendicitis. However, there are radiation dose consequences to bear in mind, especially in young children.