PROBLEM
An 18-year-old woman presents with abdominal pain in her right side. What is your interpretation of the calcific density adjacent to the right transverse process of the fourth lumbar vertebra?

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ANSWER
The correct diagnosis is an appendicolith. The stone is laminated. Note also the suggestion of a soft tissue mass directly below the calculus. During an operation, this mass proved to be an appendicolith with an associated abscess secondary to rupture of the appendix.

This series of diagnostic quizzes that challenge your ability to read a variety of x-ray films is edited by Dr. Keats, alumni professor of radiology at the University of Virginia School of Medicine in Charlottesville. Emerg Med 39(5):59-60, 2007