title: Right lower-quadrant pain-more than one diagnosis.
abstract: When a patient presents with right-lower-quadrant pain in the emergency room, the diagnosis of appendicitis must always be considered, but the differential diagnosis for this symptom includes many other etiologies. We describe a case of an 8-year-old girl with von Willebrand disease who presented with right-lower-quadrant pain and was found to have an appendiceal wall hematoma. During her evaluation, an ultrasound of the abdomen was performed, and the results were initially interpreted as an intussusception. Although ultrasound is a highly reliable way to diagnose appendicitis and intussusception, the case illustrates that the thickened abdominal wall that occurs in a mural hematoma can appear like the "target sign" that is usually associated with intussusception, and in certain clinical scenarios, alternative forms of imaging may be of value.
authors.affiliation: Emergency Medicine Education, Newark Beth Israel Hospital, Brookly, NY, USA. ctejani5@yahoo.com
authors.forename: Cena
authors.initials: C
authors.lastname: Tejani
authors.forename: Tej
authors.initials: T
authors.lastname: Phatak
authors.forename: Adam
authors.initials: A
authors.lastname: Sivitz
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis* / Q000000981:diagnostic imaging; D001064:Appendicitis / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D001065:Appendix / Q000000981:diagnostic imaging* / Q000473:pathology; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006406:Hematoma / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D007443:Intussusception / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014463:Ultrasonography; D014842:von Willebrand Diseases / Q000150:complications*