Ray Ballinger, MD, PhD

Straub Clinic and Hospital

rballinger at


11 y/o girl with abdominal pain, nausea and vomiting


abdomen all ct appendix

History and Images

11 y/o girl with abdominal pain, nausea and vomiting for two days. White Blood Cell count: 16,000

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An appendicolith is identified in the proximal appendix with a fluid-filled distal appendix and free fluid in the cul-de-sac. A thickened and enhancing wall to the appendix is noted. The diameter exceeds 1 cm and there is stranding in the adjacent fat.


Appendicolith with acute appendicitis


Surgical Pathology


The peak incidence of acute appendicitis is in the late childhood and adolescence. Clinical findings include generalized abdominal pain that later localized to the right lower quadrant, fever, loss of appetite and nausea. CT findings may include an enlarged appendix >7 mm diameter; an appendicolith; a thick, enhancing appendiceal wall; deformity or thickening of the apex of the cecum and stranding in the adjacent mesenteric fat. Peritoneal fluid may also be seen.


  1. Haaga et al. CT and MR Imaging of the Whole Body; 4th edition