DOI: 10.1097/PEC.0b013e3181e62ddb

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PMID: 20622638

Issn Print: 0749-5161

Publication Date: 2010/07/01


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Acute Abdomen: Suspected Appendicitis: Computed Tomography: Surprise

Leonard E. Swischuk

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Excerpt

This 5-year-old girl presented to our urgent care clinic (UCC) with a complaint of right-upper-quadrant abdominal pain and fever. She had no diarrhea but did have 1 episode of vomiting after an attempt was made to have her take some antipyretic medication. Her appetite was normal, and she had good oral intake. She was seen at an outside clinic the day before for fever and some cough. A chest radiograph was obtained and was considered normal (Figs. 1A, B). She was not put on any specific medication except for an antipyretic. Her abdominal pain became worse over the next 24 hours, and that is when she came to our UCC.
When she arrived at our UCC, her pulse was 120 beats per minute, and her blood pressure was within normal range. Her temperature was 38.6°C, but she was on antipyretic medication. Her respirations were 18 breaths per minute and regular. All of her physical examination was normal, and specifically, her lungs were clear to auscultations. Her abdomen was soft but tender to palpation, especially on the right. All of her laboratory studies were normal except for the white blood cell (WBC) count, which was 15,300/μL with a slight left shift. Because of the progressive abdominal pain, it was decided to obtain a computed tomography (CT) study of the abdomen and pelvis. The frontal topogram and a high abdomen-low chest axial image are presented in Figures 1C and D.
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