The case of a series "worse is better" principle by which I usually explain the probability of detection of appendicitis, particularly in the adult size children, ie worse (bigger infiltrate, abscess) appendicitis is better seen! A teenager of 14 years with complaints of pain in the right iliac region from the non-surgical department of Children City Hospital (ie surgeons excludes the surgical pathology) and with the obesity, so it's seems to be a stalemate situation, ie with such a constitution to find the appendix is likely to fail, but the "worse is better" ... At US in the right iliac region there is a tubular structure up to 3 cm in diameter with hyperechoic lesion in the base (appendicolith) without blood flow at CFM, surrounded by echogenic tissue with blood flow at CFM (omentum/omentitis), size of 10 x 10 x 7 cm (periappendicular infiltrate/abscess). external link | 
