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March 20, 1987, Vol 257, No. 11 >
ARTICLE | March 20, 1987

A 73-Year-Old Woman With Abdominal Pain in the Right Lower Quadrant FREE

Jeffrey R. Bond, MD
[+] Author Affiliations

Reprint requests to Department of Radiology, West Allis Memorial Hospital, 8901 W Lincoln Ave, West Allis, WI 53227 (Dr Bond).


JAMA. 1987;257(11):1513-1514. doi:10.1001/jama.1987.03390110089033
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References

History  A 73-year-old woman presented with a sixday history of abdominal pain that had started in the epigastrium, but recently had become more intense in the right lower quadrant. She denied experiencing nausea, vomiting, diarrhea, or gastrointestinal bleeding. Peptic ulcer had been diagnosed three years prior to presentation and had been managed medically. Hysterectomy and left oophorectomy had been performed in the remote past. On physical examination, epigastric tenderness as well as guarding and rebound tenderness in the right lower quadrant were present. Mild leukocytosis was reported. Computed tomography (CT) of the abdomen was performed (Figure).Computed tomography demonstrated a 5-cm retrocecal mass with low attenuation (fluid content) surrounded by an irregularly thickened uncalcified wall (Figure). Multiple areas of tissue debris were seen extending into the mass, but no true septation was present. No other abnormality was observed in the abdomen or pelvis.

Diagnosis  Malignant appendiceal mucocele with acute inflammation.

REFERENCES

1 +
Rokitansky CF: A Manual of Pathologic Anatomy , English translation of the Vienna edition (1842), Day GE (trans). Philadelphia, Blanchard & Lea, 1855;, vol 2, p 89.
2 +
Woodruff R, McDonald JR:  Benign and malignant cystic tumors of the appendix . Surg Gynecol Obstet 1940;;71:750-755.
3 +
Higa E, Rosai J, Pizzimbono CA, et al:  Mucosal hyperplasia, mucinous cystadenoma, and mucinous cystadenocarcinoma of the appendix . Cancer 1973;; 32:1525-1541.
4 +
Gradinski M, Rubnitz AS:  Mucocele of the appendix and pseudomyxoma peritonei . Surg Gynecol Obstet 1941;;73:345-354.
5 +
Dachman AH, Lichtenstein JE, Friedman AC:  Mucocele of the appendix and pseudomyxoma peritonei . AJR 1985;;144:923-929.
6 +
Collins DC:  71000 Human appendix specimens: A final report summarizing 40 years' study . Am J Proctol 1963;;14:365-381.
7 +
Aho AJ, Heinonen R, Lauren P:  Benign and malignant mucocele of the appendix . Acta Chir Scand 1973;;139:392-400.
8 +
Douglas NJ, Cameron DC, Nixon SJ, et al:  Intussusception of mucocele of the appendix. Gastrointest Radiol 1978;;3:97-100.
9 +
Mullen JT:  Mucocele of the appendix associated with hematochezia . South Med J 1979;;72:766-767.
10 +
Kuehn PA, Speer CS:  Mucocele of the appendix associated with profound anemia . Dis Colon Rectum 1966;;9:283-285.
11 +
Euphrat EJ:  Roentgen features of mucocele of the appendix . Radiology 1947;;48:113-117.
12 +
Li YP, Morin ME, Tan A:  Ultrasound findings in mucocele of the appendix . J Clin Ultrasound 1981;;9:406-408.
13 +
Sandler MA, Pearlberg JL, Madrazo BL:  Ultrasonic and computed tomographic features of mucocele of the appendix . J Ultrasound Med 1984;; 3:97-100.
14 +
Horgan JG, Chow PP, Richter JO, et al:  CT and sonography in the recognition of mucocele of the appendix . AJR 1984;;143:959-962.
15 +
Lund G, Lien HH:  Computed tomography of appendiceal mucocele and peritoneal pseudomyxoma . Eur J Radiol 1982;;2:88-89.
16 +
Fish B, Smulewicz JJ, Barek L:  Role of computed tomography in diagnosis of appendiceal disorders . NY State J Med 1981;, 81:900-904.
17 +
Strutynski N, Smulewicz JJ:  Mucocele of the appendix: Characteristic CT findings . Mt Sinai J Med 1981;;48:205-207.
18 +
Seshul MB, Coulam C:  Pseudomyxoma peritonei: Computed tomography and sonography . AJR 1981;;136:803-806.
19 +
Wolff M, Ahmed N:  Epithelial neoplasms of the vermiform appendix: II. Cystadenoma, papillary adenoma, and adenomatous polyps of the appendix . Cancer 1976;;37:2511-2522.
20 +
Qizelbash AH:  Mucoceles of the appendix: Their relationship to hyperplastic polyps, mucinous cystadenomas, and cystadenocarcinomas . Arch Pathol Lab Med 1975;;99:548-555.

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Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Rokitansky CF: A Manual of Pathologic Anatomy , English translation of the Vienna edition (1842), Day GE (trans). Philadelphia, Blanchard & Lea, 1855;, vol 2, p 89.
2 +
Woodruff R, McDonald JR:  Benign and malignant cystic tumors of the appendix . Surg Gynecol Obstet 1940;;71:750-755.
3 +
Higa E, Rosai J, Pizzimbono CA, et al:  Mucosal hyperplasia, mucinous cystadenoma, and mucinous cystadenocarcinoma of the appendix . Cancer 1973;; 32:1525-1541.
4 +
Gradinski M, Rubnitz AS:  Mucocele of the appendix and pseudomyxoma peritonei . Surg Gynecol Obstet 1941;;73:345-354.
5 +
Dachman AH, Lichtenstein JE, Friedman AC:  Mucocele of the appendix and pseudomyxoma peritonei . AJR 1985;;144:923-929.
6 +
Collins DC:  71000 Human appendix specimens: A final report summarizing 40 years' study . Am J Proctol 1963;;14:365-381.
7 +
Aho AJ, Heinonen R, Lauren P:  Benign and malignant mucocele of the appendix . Acta Chir Scand 1973;;139:392-400.
8 +
Douglas NJ, Cameron DC, Nixon SJ, et al:  Intussusception of mucocele of the appendix. Gastrointest Radiol 1978;;3:97-100.
9 +
Mullen JT:  Mucocele of the appendix associated with hematochezia . South Med J 1979;;72:766-767.
10 +
Kuehn PA, Speer CS:  Mucocele of the appendix associated with profound anemia . Dis Colon Rectum 1966;;9:283-285.
11 +
Euphrat EJ:  Roentgen features of mucocele of the appendix . Radiology 1947;;48:113-117.
12 +
Li YP, Morin ME, Tan A:  Ultrasound findings in mucocele of the appendix . J Clin Ultrasound 1981;;9:406-408.
13 +
Sandler MA, Pearlberg JL, Madrazo BL:  Ultrasonic and computed tomographic features of mucocele of the appendix . J Ultrasound Med 1984;; 3:97-100.
14 +
Horgan JG, Chow PP, Richter JO, et al:  CT and sonography in the recognition of mucocele of the appendix . AJR 1984;;143:959-962.
15 +
Lund G, Lien HH:  Computed tomography of appendiceal mucocele and peritoneal pseudomyxoma . Eur J Radiol 1982;;2:88-89.
16 +
Fish B, Smulewicz JJ, Barek L:  Role of computed tomography in diagnosis of appendiceal disorders . NY State J Med 1981;, 81:900-904.
17 +
Strutynski N, Smulewicz JJ:  Mucocele of the appendix: Characteristic CT findings . Mt Sinai J Med 1981;;48:205-207.
18 +
Seshul MB, Coulam C:  Pseudomyxoma peritonei: Computed tomography and sonography . AJR 1981;;136:803-806.
19 +
Wolff M, Ahmed N:  Epithelial neoplasms of the vermiform appendix: II. Cystadenoma, papillary adenoma, and adenomatous polyps of the appendix . Cancer 1976;;37:2511-2522.
20 +
Qizelbash AH:  Mucoceles of the appendix: Their relationship to hyperplastic polyps, mucinous cystadenomas, and cystadenocarcinomas . Arch Pathol Lab Med 1975;;99:548-555.

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