Case of the Month #150 Canadian Association of Radiologists Journal

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Case of the Month #150 Canadian Association of Radiologists Journal Arifa Sadaf, FRCR, Ian Hammond, MD, FRCPC, FACR Canadian Association of Radiologists Journal Volume 60, Issue 2, Pages 110-111 (April 2009) DOI: 10.1016/j.carj.2009.02.025 Copyright © 2009 Canadian Association of Radiologists Terms and Conditions

Figure 1 Transverse ultrasound image of the right lower quadrant shows poorly marginated hypoechoic/cystic tender abnormality (A) consistent with a small abscess. Note the linear echogenic object within the collection, in keeping with toothpick (double thin arrows) with a portion of it (single arrow) extending beyond the confines of the abscess cavity. R = rectus muscle; C = cecum. Canadian Association of Radiologists Journal 2009 60, 110-111DOI: (10.1016/j.carj.2009.02.025) Copyright © 2009 Canadian Association of Radiologists Terms and Conditions

Figure 2 Non-enhanced CT image of the right iliac fossa shows hyperdense toothpick (arrows) seen perforating through the medial wall of the cecum (C). Note the inflammatory stranding (A) in the pericecal fat surrounding the toothpick. IP = iliopsoas; R = rectus muscle. Canadian Association of Radiologists Journal 2009 60, 110-111DOI: (10.1016/j.carj.2009.02.025) Copyright © 2009 Canadian Association of Radiologists Terms and Conditions

Figure 3 Enhanced transverse CT image, same level as figure 2, again demonstrates pericecal inflammation. Toothpick (arrows) is not as clearly discernible as on non enhanced image in Figure 2, due to enhancing phlegmonous inflammation around it (A). IP = iliopsoas; R = rectus muscle; C = cecum. Canadian Association of Radiologists Journal 2009 60, 110-111DOI: (10.1016/j.carj.2009.02.025) Copyright © 2009 Canadian Association of Radiologists Terms and Conditions