Purpose or Case Report: Appendicitis is an important cause of abdominal pain and is the leading reason for emergent surgery in children. Prompt and accurate diagnosis is important because delayed diagnosis increases the risk of rupture and false positive diagnosis may result in unnecessary surgery. While it can occur at any age, it most frequently occurs in pediatric patients. Further, the rate of perforation is higher in younger children. However, the differential diagnosis for pediatric abdominal pain is broad and includes many non-surgical diagnoses. Localization of pain can also be more difficult in children, posing an additional challenge. In this educational exhibit, we will discuss some clinical mimics of appendicitis and characteristic imaging findings to help differentiate them. Topics covered include omental infarct, typically a self-limited condition, but a cause of abdominal pain that has been identified in 0.024 to 0.1% of cases of surgery for appendicitis. In the rare cases that do require surgery, the surgical approach differs from that for appendicitis. In addition, we will discuss epiploic appendagitis, yet another self limiting condition in which proper diagnosis prevents unnecessary surgery. We will discuss Meckel’s diverticulum, which when inflamed may mimic acute appendicitis very closely in imaging appearance as well as clinical presentation. However, these entities can be differentiated if the inflamed structure can be identified as arising from the ileum rather than the cecum. Finally, we will also discuss other clinical appendicitis mimics such as mesenteric adenitis, inflammatory bowel disease, ileocolic intussusception, and ovarian torsion, and we will contrast the imaging appearance of lymphoid hyperplasia of the appendix with acute appendicitis.
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