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May 1994

Radiological Cases of the Month: Case 2

Author Affiliations

From the Departments of Radiology and Pediatrics, Childrens Hospital Los Angeles, and University of Southern California, Los Angeles.

Arch Pediatr Adolesc Med. 1994;148(5):527-528. doi:10.1001/archpedi.1994.02170050085018

AN 8½-YEAR-OLD boy with hemoglobin E–β-thalassemia disease requiring monthly transfusions and chronic iron chelation therapy with deferoxamine presented with a 1-week history of right lower quadrant abdominal pain, temperature of 39°C, and purulent diarrhea. Physical examination elicited right lower quadrant abdominal tenderness and guarding. Shotty bilateral inguinal lymph nodes were palpated. Laboratory evaluation revealed a white blood cell count of 31×106/L with 0.70 polymorphonuclear leukocytes and 0.06 forms. No appendicolith was detected on an abdominal roentgenogram. The child was subsequently admitted to the hospital for further imaging studies including abdominal ultrasonography (Figure 1) and ab) dominal computed tomography (Figure 2). Diagnostic considerations included acute appendicitis and mesenteric adenitis. Exploratory laparotomy with appendectomy and lymph node biopsy was performed. The appendix appeared grossly inflamed, and multiple purulent lymph nodes were present. Histopathologic examination revealed histiocytic, necrotizing, granulomatous inflammatory tissue and suppurative abscess formation. No organisms were identified on histologic

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