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Image of the Month—Quiz Case

SreyRam Kuy, MD, MHS; Matt Vickery, BS; Anahita Dua, MD; Gregory Rosner, MD
JAMA Surg. 2013;148(5):481. doi:10.1001/jamasurg.2013.302a.
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A 37-year-old woman with a history of cyclic lower abdominal pain and nausea presented to the emergency department with acute-onset right lower quadrant (RLQ) pain and nausea for 1 day, but no fever. Vital signs were normal. Physical examination revealed RLQ tenderness. Laboratory examination included a urinalysis, the result of which was negative, and a white blood cell count, which revealed a mild leukocytosis of 11.6 K/μL. Pelvic ultrasonography was obtained, which showed a right ovarian cyst but without evidence of torsion. Computed tomography (CT) of the abdomen/pelvis was performed, which showed an enlarged, dilated appendix of 11 mm in diameter (Figure 1), which on comparison with a prior CT examination from 5 years prior showed a similarly enlarged, dilated appendix.

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Figure 1. Computed tomography of the abdomen and pelvis.

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Figure 2. Intraoperative image of the appendix.

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Figure 3. Histologic image of the appendiceal specimen with glands and stroma.




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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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