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Perforated appendicitis with periappendiceal abscess

Case contributed by Michael P Hartung
Diagnosis certain


Right flank pain and hematuria.

Patient Data

Age: 70
Gender: Female

Dilated appendix with periappendiceal inflammation. Abutting the cranial aspect of the mid/distal appendix is a collection containing fluid and mottled air with surrounding inflammation, consistent with periappendiceal abscess. The right ureter closely approximates this collection, and becomes mildly thickened as it passes along the posterior margin. Incidental note of hepatic steatosis. 

Case Discussion

This is a nice variation on the typical perforated appendicitis case. The patient was imaged with a non-contrast renal stone study because she had right flank pain and hematuria. 

There is clearly a perforated appendix with periappendiceal abscess containing fluid and air. But how did she get hematuria? The right ureter passes along the posterior margin of the abscess and becomes focally thickened, indicating reactive inflammation, the mostly likely cause of her hematuria. 

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