Radiology In Ped Emerg Med, Vol 6, Case 18

Appendicoliths
Radiology Cases in Pediatric Emergency Medicine
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.


View close up view of right lower quadrant.


View pointers.


Case B - 17 year old female.


View close up view of right lower quadrant.


View pointers.


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


View close up view of right lower quadrant.


View pointers.


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


View close up view of right lower quadrant.


View pointers.


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


View close up view of right lower quadrant.


View pointers.


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


View close up view of right lower quadrant.


View pointers.


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


View close up view of right lower quadrant.


View pointers.


Case H - 8 year old female.


View close up view of right lower quadrant.


View pointers.


Case I - 9 year old female.


View close up view of right lower quadrant.


View pointers.


Case J - 8 year old male.


View close up view of right lower quadrant.


View pointers.


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


View close up view of right lower quadrant.


View pointers.


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


View close up view of right lower quadrant.


View pointers.


Case M - 3 year old male.


View close up view of right lower quadrant.


View pointers.


Case N - 6 year old male.


View close up view of right lower quadrant.


View pointers.


Case O - 17 month old female.


View close up view of right lower quadrant.


View pointers.


Case P - 15 year old male.


View close up view of right lower quadrant.


View pointers.