Presentation
2 weeks periumbilical pain.
Patient Data
In the right iliac fossa, medial to the cecum and a focus of calcific density is demonstrated located within what appears to be the appendix, and thus presumably representing an appendicolith. Some slight stranding is seen around this region, with prominent mesenteric lymph nodes, but no perforation or abscess formation is evident.
Otherwise the solid and hollow abdominal viscera are unremarkable. No free fluid or free gas. No nodal enlargement. No focal osseous lesion. Lung bases are unremarkable.
Conclusion:
Appendicolith in this clinical setting, even with only minimal periappendiceal stranding, suspicious for appendicitis.
The patient went on to have surgery.
Histology
MACROSCOPIC DESCRIPTION: The specimen is an appendix 70mm long and 5mm in diameter. Immediately adjacent to the base is a fusiform dilated area spanning 20mm with the diameter up to 12mm. Within the lumen is a solid fecalith. There is otherwise no perforation or fibrinopurulent exudate.
MICROSCOPIC DESCRIPTION: Sections of the appendix show no mucosal ulceration. Scattered neutrophils are seen in the mucosa. Reactive lymphoid follicles are present within the wall. The serosa is unremarkable. There is no evidence of malignancy.
DIAGNOSIS: Acute appendicitis.
In retrospect on the supine view the appendicolith is visible just above the iliac spine (red arrow)
Case Discussion
In the setting of appropriate symptoms the visualization of an appendicolith, even with only minimal periappendiceal stranding, is suspicious for appendicitis. In pediatric practice, CT is infrequently obtained and as such this sign is of greater importance.
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