Ultrasonography is particularly useful in children because it can be repeated without ionizing radiation and can be adapted to the clinical question during the examination. A 10-year-old boy with right lower quadrant pain, right leg pain, and a limp was referred with suspected acute appendicitis. A comprehensive diagnostic ultrasound examination of the abdomen demonstrated a normal appendix and an enlarged lymph node corresponding to the site of right lower quadrant tenderness. During the examination, conversation with the patient and his mother disclosed household cat ownership, frequent exposure to cat fleas, and multiple flea bites. The abdominal findings, exposure history, and pre-existing right leg symptoms were shared with the clinical team. At the physician's request, additional ultrasound evaluation of the right popliteal region demonstrated a second enlarged, tender lymph node. Superb microvascular imaging showed nonspecific vascular signals predominantly near the hila of both nodes. Serologic and molecular testing for Bartonella henselae was not performed; therefore, cat-scratch disease remained a clinical suspicion rather than a confirmed diagnosis. After azithromycin treatment, the symptoms improved and both lymph nodes decreased in size on follow-up ultrasonography. This case does not establish an ultrasonographic diagnosis of cat-scratch disease. Rather, it illustrates how ultrasonography provided anatomic correlates for symptoms at two sites, complemented the information available from clinical assessment alone, and supported noninvasive follow-up.

Acute appendicitis is a leading cause of acute abdomen, yet its onset after blunt trauma remains exceedingly rare and diagnostically challenging - particularly in the elderly and in patients with concurrent neurological injuries. We present the case of a 65-year-old woman who developed acute appendicitis following a motor vehicle collision that also caused thoracic spinal fractures with canal involvement. Initially hemodynamically stable with a normal abdominal examination and a negative focused assessment with sonography for trauma, she developed right lower quadrant pain 22 h posttrauma, which localized and intensified by 56 h. Contrast-enhanced computed tomography (CT) at 59 h revealed an 8-mm inflamed appendix with periappendiceal fat stranding, and open appendectomy at 61 h confirmed acute appendicitis with fibrous obliteration. The patient's recovery was uneventful. This case underscores how concurrent spinal injury and immobilization can obscure evolving abdominal pathology, emphasizing the importance of repeated clinical assessment and timely CT imaging in elderly polytrauma patients. In addition to the case presentation, we conducted a comprehensive literature review of all reported cases of posttraumatic appendicitis, summarizing demographic, clinical, and diagnostic patterns to contextualize this rare phenomenon. Together, these findings reinforce the need for heightened diagnostic vigilance and multidisciplinary coordination when evaluating delayed abdominal pain in trauma patients with neurological compromise.

BACKGROUND Hydatid disease, caused by Echinococcus granulosus, is an endemic parasitic infection that predominantly affects the liver. Although slow-growing and asymptomatic, large hepatic cysts lead to catastrophic vascular complications, including inferior vena cava (IVC) thrombosis and pulmonary embolism (PE). Although rare, life-threatening events require prompt recognition and multidisciplinary management to optimize outcomes. CASE REPORT A 68-year-old woman with paroxysmal atrial fibrillation presented with right upper-quadrant pain, fever, and poor oral intake for several weeks. Examination revealed abdominal distension, hepatomegaly, and mottled, cold lower limbs. Laboratory findings showed severe metabolic acidosis and leukocytosis, indicating significant systemic involvement and possible sepsis. Computed tomography (CT) angiography demonstrated a pulmonary embolism, a giant (29×18 cm) right hepatic cyst exerting a mass effect, and extensive thrombosis extending from the infrarenal IVC to both external iliac veins. Echocardiography showed extrinsic cardiac compression without signs of tamponade but with functional compromise related to mass effect. Management included anticoagulation, albendazole, broad-spectrum antibiotics, vasopressors, and continuous renal replacement therapy. Ultrasound-guided percutaneous drainage of the cyst yielded 4 L of purulent fluid, with transient improvement in limb perfusion suggesting partial decompression of venous outflow obstruction. An IVC filter was inserted, but despite intensive therapy, the patient developed refractory shock and died due to progressive hemodynamic collapse and multiorgan failure. CONCLUSIONS Massive hepatic hydatid cysts can precipitate IVC thrombosis and PE through mechanical compression or infection-related inflammation. Early diagnosis, multidisciplinary coordination, and timely surgical or percutaneous decompression are vital to prevent death.

This report presents an unusual case of persistent groin and lower abdominal pain following robotic-assisted inguinal hernia repair (R-IHR), along with a brief review of the literature. To our knowledge, this is the first reported case of pubic symphysis stress reaction with adjacent pelvic girdle myositis following R-IHR, a musculoskeletal complication pairing not previously described in the hernia repair or robotic surgery literature. Imaging findings revealed edema and capsular hypertrophy at the pubic symphysis with diffuse pelvic girdle myositis on magnetic resonance imaging (MRI), findings not captured on computed tomography (CT), suggesting a postoperative biomechanical mechanism. The specific robotic surgical technique (transabdominal preperitoneal vs. totally extraperitoneal) used in this case could not be confirmed, as the original operative report was not available to the authors at the time of this report; the general term R-IHR is used throughout to reflect this uncertainty. A 41-year-old physically active man presented more than one year after R-IHR, complaining of progressively worsening right groin and lower abdominal pain. The pain was moderate to severe, dull, and aching, with intermittent sharp, stabbing episodes. It was exacerbated by bending, coughing, bowel movements, prolonged sitting, recumbency, exercise, and sexual activity. He reported no weakness, bowel or bladder dysfunction, or systemic symptoms. Examination revealed focal tenderness in the right inguinal region and right lower abdominal quadrant without rebound tenderness, no signs of psoas involvement, and normal strength, range of motion, neurologic function, and gait. Pelvic CT was unremarkable, showing only bilateral hydroceles. Pelvic MRI demonstrated edema and capsular hypertrophy along both sides of the pubic symphysis, with multifocal intramuscular enhancement in the right gluteus medius, bilateral adductor muscles, and gluteus maximus, consistent with myositis. Inflammatory laboratory workup was negative. The Douleur Neuropathique 4 questionnaire indicated nociceptive rather than neuropathic pain. These findings suggest that biomechanical stress and microtrauma to the pubic symphysis during surgery initiated a local inflammatory cascade. The patient had declined postoperative physical therapy, citing high baseline fitness; prolonged activity restriction over 12 months provided no relief. Persistent groin pain following R-IHR warrants consideration of pubic symphysis stress reaction and adjacent myositis, particularly when CT is nondiagnostic and neurologic examination is normal. MRI may be necessary to identify underlying musculoskeletal pathology and guide management. This case further highlights the clinical risk of physically fit patients declining structured rehabilitation; general conditioning does not substitute for targeted postoperative physical therapy.

Ovarian vein thrombosis (OVT) is a rare vascular disorder most commonly associated with pregnancy and the puerperium; however, it may also occur in non-pregnant women, in whom diagnosis can be challenging because of its rarity and nonspecific clinical presentation. We report the case of a 37-year-old non-pregnant woman with no significant past medical history who presented with a one-month history of undocumented fever associated with right lower quadrant abdominal pain and constitutional symptoms, including weight loss, night sweats, and fatigue. She had delivered nine months before presentation, well beyond the recognized high-risk postpartum period, and denied oral contraceptive use. Laboratory investigations were largely unremarkable, except for a markedly elevated erythrocyte sedimentation rate. Contrast-enhanced computed tomography of the abdomen and pelvis demonstrated bilateral OVT. The patient was admitted with a working diagnosis of fever of unknown origin and was started on therapeutic anticoagulation with low-molecular-weight heparin, followed by a transition to apixaban. Her condition improved clinically, and a structured follow-up plan was arranged. Bilateral OVT in the absence of pregnancy is particularly uncommon and may be overlooked because of the lack of specific clinical and laboratory findings, making imaging essential for diagnosis. Early initiation of anticoagulation is important to reduce the risk of potentially life-threatening complications. Although direct oral anticoagulants are increasingly used in the management of venous thromboembolism, evidence supporting their use specifically in non-pregnancy-related OVT remains limited. This case highlights bilateral OVT as a rare but important cause of prolonged fever and abdominal pain in non-pregnant women and emphasizes the need for early recognition to avoid diagnostic delay and ensure timely management.

Appendiceal goblet cell adenocarcinoma (GCA) is a rare malignancy that often presents as acute appendicitis. We present a 57-year-old woman with a history of breast cancer who presented with right lower quadrant pain, fever, nausea, and vomiting and underwent appendectomy for presumed uncomplicated appendicitis. She was discharged postoperatively, and final pathology subsequently revealed GCA of the appendix. Approximately one week later, she returned with dyspnea and was found to have a new, multiloculated, exudative pleural effusion. Pleural fluid cytology was negative for malignancy. She required chest tube placement with intrapleural fibrinolytics followed by surgical decortication for definitive management. Given recent surgeries and concern that early positron emission tomography/computed tomography (PET-CT) would be confounded by postoperative inflammation, a multidisciplinary decision was made to initiate systemic chemotherapy prior to right hemicolectomy. She later underwent hemicolectomy with a favorable outcome and no evidence of peritoneal metastasis. This case highlights an unusual extraperitoneal manifestation of appendiceal GCA and an individualized treatment sequence differing from standard management, underscoring the need for further study of optimal treatment sequencing and surveillance strategies.

Acute appendicitis may mask rare surgical emergencies. Torsion of an intra-abdominal undescended testis with malignancy is exceptionally uncommon. A 27-year-old man presented with 3 days of right lower quadrant pain, vomiting, and anorexia. Examination showed peritonitis and an absent right testis. Laparotomy for presumed appendicitis revealed a normal appendix and an 11 × 13 × 12 cm intra-abdominal mass with a 540° torsed spermatic cord. Right radical orchiectomy was performed. Histopathology confirmed classical seminoma. Final stage was pT2N0M0S0 Stage IB. Giant torsed seminoma can mimic appendicitis; genital examination is essential.

Atrial fibrillation (AF) is a rare cardiac rhythm disturbance in the pediatric population. It is exceedingly uncommon in otherwise healthy individuals without structural heart disease or known genetic predisposition. This case describes rate-controlled AF in a previously healthy adolescent presenting to the emergency department with one week of right lower quadrant abdominal pain and associated nausea. The patient subsequently spontaneously converted to normal sinus rhythm, underwent an unremarkable cardiac evaluation at a tertiary care center, and was discharged home in excellent condition. Despite the patient's benign course in this instance, new-onset AF in pediatric patients should always warrant admission and comprehensive evaluation to exclude underlying pathology.

Abdominal angiostrongyliasis (AA) is an emerging infection caused by the nematode Angiostrongylus costaricensis. Human infection occurs through ingestion of food contaminated with infective third-stage larvae (L3). Although endemic in Central and South America, AA remains underdiagnosed and underrecognized in clinical practice. We report the case of a female patient with a history of bariatric surgery, residing in southern Brazil, who presented with right lower quadrant abdominal pain and mild eosinophilia. Initial diagnostic hypotheses included infectious colitis, neoplasia and ischemic processes. Following surgical intervention and histopathological examination, AA was confirmed by identification of the parasite within a mesenteric artery. This case highlights an atypical presentation and definitive diagnosis established by histopathology despite negative polymerase chain reaction (PCR) results. This report underscores the importance of including AA in the differential diagnosis of abdominal conditions particularly in endemic regions. It also emphasizes the need for enhanced specificity of serological and molecular diagnostic methods.

A 10-year-old male with a prior history of right epididymitis presented to the emergency department with a one-day history of right lower quadrant abdominal and right testicular pain. His initial examination was notable for café-au-lait macules and axillary freckling. An evaluation with renal ultrasound demonstrated mild left hydronephrosis, and subsequent testicular ultrasound was concerning for right epididymo-orchitis. A right lower quadrant abdominal ultrasound revealed a heterogeneous mass, and a CT of the abdomen and pelvis with and without contrast confirmed a large 14 cm × 16 cm × 16 cm hypoenhancing mass extending through the right lower mesentery and enveloping mesenteric vessels. An abdominal mass biopsy revealed a plexiform neurofibroma, and the patient met the criteria for neurofibromatosis type 1. He underwent resection of the plexiform neurofibroma, and further imaging revealed other neurofibromas. This case report highlights the importance of considering anatomic explanations for recurrent epididymitis in sexually naïve males and the importance of visual awareness during the physical examination, as neurocutaneous findings can influence the final diagnosis.

Lymphangiomas are benign tumors of lymphatic origin that usually arise in the neck and axilla during childhood; intra-abdominal involvement is rare, and an omental origin in an adult is exceptional. Because imaging features are non-specific, preoperative diagnosis is difficult, and intra-cystic hemorrhage can transform an otherwise indolent lesion into a surgical emergency. We report the case of a 46-year-old man who presented with sudden right lower-quadrant abdominal pain and a soft, mobile, tender right-abdominal mass. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) revealed a giant (approximately 25 cm), thin-walled, multilocular cystic mass containing a hematoma, with enhancement of the cyst walls but not the internal component, and feeding vessels arising from the greater omentum. Tumor markers were normal apart from mildly elevated carbohydrate antigen (CA) 125. Because malignancy could not be excluded, open resection was performed; the tumor arose from the greater omentum without invading adjacent organs and was completely excised. Histopathology confirmed an omental lymphangioma. The acute presentation was attributable to intra-cystic hemorrhage with a focal, self-sealed rupture superimposed on an indolent lesion. Because cross-sectional imaging cannot reliably distinguish lymphangioma from other cystic lesions, an immunohistochemical panel combining lymphatic and vascular endothelial markers (D2-40, CD31) with mesothelial markers (calretinin, WT-1) was decisive in excluding a mesothelial-lined cyst and mesothelioma. Omental lymphangioma should be considered in the differential diagnosis of a giant intra-abdominal multilocular cystic mass in adults, including those presenting acutely, and complete excision is both diagnostic and curative.

Colonic diverticulitis is rare in the pediatric population and often presents with nonspecific symptoms that may be misdiagnosed as other causes of acute abdominal pain, such as appendicitis, leading to diagnostic uncertainty and variability in management. We report a case of pediatric colonic diverticulitis and present a systematic review to characterize its clinical presentation, diagnostic challenges and management. Clinical data for the index patient were retrospectively reviewed, and parental consent was obtained. A structured literature search was performed using PubMed, Scopus, and Embase. Studies reporting patients younger than 18 years were included. A 16-year-old male presented with right lower quadrant pain. CT suggested cecal diverticulitis. Worsening symptoms prompted diagnostic laparoscopy, revealing an inflamed diverticulum adjacent to a normal appendix. The postoperative course was uneventful. The review identified 27 studies including 101 patients. Median age was 14 years (IQR 12-16; range 3-17), with 57% male preponderance. Most cases involved a solitary right-sided diverticulum. CT correctly identified diverticulitis in 85%. Complicated disease occurred in 17%. In conclusion, in the pediatric age diverticulitis often arises from a solitary cecal diverticulum and can closely mimic appendicitis. Awareness may improve diagnosis, and uncomplicated cases can be treated conservatively with careful follow-up and appropriate clinical monitoring.

Appendiceal neuroendocrine tumors (NETs), historically referred to as carcinoid tumors, are the most common primary neoplasms of the appendix and are frequently diagnosed incidentally following surgery for suspected acute appendicitis. Preoperative diagnosis is uncommon because their clinical presentation often mimics inflammatory appendiceal disease. We report the case of a 30-year-old male who presented with a 48-hour history of right lower quadrant abdominal pain, nausea, vomiting, and fever, consistent with acute appendicitis. Due to clinical suspicion of complicated appendicitis, the patient underwent emergency exploratory laparotomy. Intraoperative exploration revealed a firm heterogeneous mass measuring approximately 6 cm involving the appendix, cecum, and ileocecal valve, prompting en bloc surgical resection with protective ileostomy. Gross examination demonstrated an exophytic appendiceal mass with irregular contours. Histopathological analysis confirmed a well-differentiated appendiceal neuroendocrine tumor with negative surgical margins. Postoperative thoracoabdominopelvic computed tomography showed no evidence of lymph node involvement, local recurrence, or distant metastases. The patient experienced an uneventful postoperative recovery and was referred for oncologic follow-up. This case highlights the importance of considering appendiceal neoplasms in patients presenting with acute appendicitis and underscores the role of intraoperative assessment, histopathological evaluation, and appropriate surgical management in achieving favorable outcomes.