ABSTRACT
A 9-year-old female presents with a few days of worsening right-sided abdominal pain, vomiting, fever, and inability to tolerate oral intake. On examination she is ill-appearing, with focal right-sided tenderness to palpation and some voluntary guarding. She has one episode of emesis in the emergency department. Her history and exam are concerning for a possible appendicitis so an IV is placed, labs are drawn, and an ultrasound is ordered as a first diagnostic imaging study. Her labs return unremarkable, with a normal white blood cell count and normal inflammatory markers. While the patient is in radiology getting her ultrasound, you receive a call from the radiologist alerting you to an abnormal and emergent finding (see Image 65.1).
