A young woman complained of three days of lower abdominal and right iliac fossa pain. On examination there was an ill defined mass in the right iliac fossa at the point of maximal tenderness.
A rounded mass was seen in the right iliac fossa, overlying the iliac vessels. The mass is hetrogenous with a predominantly echolucent areas posteriorly. Within the superior portion of the mass there is a blind ended tubular structure which, on high frequency imaging, displays layers suggestive of "bowel signature". This is suggestive of the appendix. There is increased echogenicity of the fat surrounding the mass suggesting inflammation.
The position of the abscess and clinical history suggested appendiceal abscess as the most likely diagnosis. It is uncommon to see the appendix within the abscess as perforation can result in "deflation" of the previously tense appendix and necrosis can cause loss of the usual layers of the bowel signature, which makes it more difficult to identify the appendix.