Atypical Clinical Presentation: Appendix in the Right Paracolic Gutter


Non-perforated appendicitis mimicking pyelonephritis.

8 year old boy with a history of right flank tenderness and pyuria. CT scan, shown below, was obtained to rule out pyelonephritis.

Axial CT image at the level of the lower pole of the right kidney demonstrates a dilated appendix (large white arrow) in the right flank. Inflammatory changes are present in the periappendiceal and perinephric fat (small black arrowheads).
At surgery, an inflamed non-perforated appendix was removed. Following surgery, the patient's urinary tract symptoms resolved, and he was discharged home in good condition.

Related teaching points can also be found in CT Findings

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