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Updated: May 17, 2026
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Quantifying Pain Location and Intensity with Multimodal Pain Body Diagrams
Published on: July 7, 2023
Right lower-quadrant pain-more than one diagnosis
Cena Tejani1, Tej Phatak, Adam Sivitz
1Emergency Medicine Education, Newark Beth Israel Hospital, Brookly, NY, USA. ctejani5@yahoo.com
Pediatric Emergency Care
|November 7, 2012
Summary
Right-lower-quadrant pain can mimic appendicitis. An appendiceal wall hematoma in a child with von Willebrand disease mimicked intussusception on ultrasound, highlighting the need for advanced imaging in complex cases.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Hematology
Background:
- Right-lower-quadrant pain is a common emergency room presentation with a broad differential diagnosis, including appendicitis.
- Von Willebrand disease is a congenital bleeding disorder that can predispose patients to bleeding complications.
Observation:
- An 8-year-old girl with known von Willebrand disease presented with acute right-lower-quadrant pain.
- Initial abdominal ultrasound revealed findings suggestive of intussusception, specifically a "target sign" due to a thickened abdominal wall.
Findings:
- The patient was diagnosed with an appendiceal wall hematoma, a rare complication.
- The appendiceal wall hematoma mimicked the ultrasound appearance of intussusception, demonstrating a potential diagnostic pitfall.
Implications:
- This case underscores the importance of considering rare diagnoses in patients with bleeding disorders presenting with abdominal pain.
- It highlights the limitations of ultrasound in differentiating certain abdominal pathologies and suggests that advanced imaging modalities may be necessary.
- Accurate diagnosis is crucial for appropriate management and to avoid unnecessary interventions.
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