An unusual case of appendicitis.  The surgical team were suspicious clinically and the CT confirms appendicitis.  However, it is unusual to have such a large amount of gas in an inflammed appendix.  In fact, one of the ultrasound features that would sway you away from the diagnosis would be gas within the viscus.

Moreover, the fatty lump at the neck of the appendix is unusual.

Appendicitis was confirmed at pathological examination.