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Case 18 - Appendicoliths

Appendicoliths

Volume 6, Case 18
Loren G. Yamamoto, MD, MPH
Kapiolani Medical Center For Women And Children
University of Hawaii John A. Burns School of Medicine
Collin S. Goto, MD
Children's Medical Center of Dallas
University of Texas Southwestern School of Medicine

Recognizing an appendicolith (fecalith) on abdominal radiographs can be difficult. Since the presence of an appendicolith on abdominal radiographs is highly indicative of appendicitis, identifying a subtle appendicolith is critical. These 16 cases of radiographic appendicoliths demonstrate how difficult it is to identify these reliably. See if you can identify the appendicoliths in all these radiographs.

For each case, the first image shows the abdominal films. The second image displays a close up view of the right lower quadrant. The third image displays pointers identifying the appendicolith(s).

Case A - 7 year old female.

Abdominal film for Case A.

View close up view of right lower quadrant.

Close up view of right lower quadrant for Case A.

View pointers.

Pointers identifying appendicolith for Case A.

Case B - 17 year old female.

Abdominal film for Case B.

View close up view of right lower quadrant.

Close up view of right lower quadrant for Case B.

View pointers.

Pointers identifying appendicolith for Case B.

Case C - 2-1/2 year old male.

Abdominal film for Case C.

View close up view of right lower quadrant.

Close up view of right lower quadrant for Case C.

View pointers.

Pointers identifying appendicolith for Case C.

Case D - 9 year old obese female with a retrocecal appendicitis.

Abdominal film for Case D.

View close up view of right lower quadrant.

Close up view of right lower quadrant for Case D.

View pointers.

Pointers identifying appendicolith for Case D.

Case E - 8 year old female (supine view only).

Abdominal film for Case E.

View close up view of right lower quadrant.

Close up view of right lower quadrant for Case E.

View pointers.

Pointers identifying appendicolith for Case E.

Case F - 8 year old male (supine and prone views only).

Abdominal film for Case F.

View close up view of right lower quadrant.

Close up view of right lower quadrant for Case F.

View pointers.

Pointers identifying appendicolith for Case F.

Case G - 14 year old female (1 view only). This image shows a radiograph of the appendix surgical specimen containing the appendicolith.

Abdominal film for Case G.

View close up view of right lower quadrant.

Close up view of right lower quadrant for Case G.

View pointers.

Pointers identifying appendicolith for Case G.

Case H - 8 year old female.

Abdominal film for Case H.

View close up view of right lower quadrant.

Close up view of right lower quadrant for Case H.

View pointers.

Pointers identifying appendicolith for Case H.

Case I - 9 year old female.

Abdominal film for Case I.

View close up view of right lower quadrant.

Close up view of right lower quadrant for Case I.

View pointers.

Pointers identifying appendicolith for Case I.

Case J - 8 year old male.

Abdominal film for Case J.

View close up view of right lower quadrant.

Close up view of right lower quadrant for Case J.

View pointers.

Pointers identifying appendicolith for Case J.

Case K - Not sure of this patient's age.

Abdominal film for Case K.

View close up view of right lower quadrant.

Close up view of right lower quadrant for Case K.

View pointers.

Pointers identifying appendicolith for Case K.

Case L - Not sure of this patient's age.

Abdominal film for Case L.

View close up view of right lower quadrant.

Close up view of right lower quadrant for Case L.

View pointers.

Pointers identifying appendicolith for Case L.

Case M - 3 year old male.

Abdominal film for Case M.

View close up view of right lower quadrant.

Close up view of right lower quadrant for Case M.

View pointers.

Pointers identifying appendicolith for Case M.

Case N - 6 year old male.

Abdominal film for Case N.

View close up view of right lower quadrant.

Close up view of right lower quadrant for Case N.

View pointers.

Pointers identifying appendicolith for Case N.

Case O - 17 month old female.

Abdominal film for Case O.

View close up view of right lower quadrant.

Close up view of right lower quadrant for Case O.

View pointers.

Pointers identifying appendicolith for Case O.

Case P - 15 year old male.

Abdominal film for Case P.

View close up view of right lower quadrant.

Close up view of right lower quadrant for Case P.

View pointers.

Pointers identifying appendicolith for Case P.