Case contributed by Dachani Kansan Naider
Diagnosis certain


Right lower quadrant abdominal pain and anorexia. No fever. Last menstrual period 2 weeks ago.

Patient Data

Age: 30 years
Gender: Female
  • the retrocecal appendix is significantly engorged
  • there is periappendiceal fat stranding and inflammatory phlegmon
  • no periappendiceal abscess
  • no hollow viscus perforation
  • there is an appendicolith identified at the origin of the appendix
  • the inflamed appendix extends inferomedially towards the right ovary
  • multiple enlarged lymph nodes are demonstrated in the right colic nodal station
  • the right ovary is enlarged and appears inflamed 
  • there is an associated extensive thrombus within the right gonadal vein
  • the thrombus measures up to at least 125 mm in maximal length 
  • there is no extension of the thrombus into the IVC

Key images 1, 2, 3


Key image 1 - this coronal view highlights the following:

  • the inflamed appendix extending inferomedially towards the right ovary
  • the right ovary appears enlarged and inflamed 

Key image 2 - this axial view shows:

  • a thrombus within the right gonadal vein

Key image 3 - this coronal view shows:

  • the extensive right gonadal vein thrombus measuring up to at least 125 mm in maximal length

Case Discussion

This is a case of acute appendicitis with inflammatory changes extending to the right ovary. The right ovary inflammation is most likely reactive in nature due to its close proximity to the inflamed appendix. There is also an extensive thrombus within the right gonadal vein; potentially related to the inflammation of the right ovary.

Patient underwent an uncomplicated laparoscopic appendectomy. Histology report confirms the diagnosis of acute suppurative appendicitis. 

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