Each month, Dr. Maria Flynn issues a Radiology Challenge, presenting images from one of a variety of imaging modalities and a case report. Can you diagnose the condition? Follow the link to find out whether your answer was correct, what was really wrong with the patient, and how the patient was treated. Then, come back next month to test your radiographic reading skills on a new case!

Dr. Maria Flynn is Chief of Genitourinary Imaging and Radiology Intern/Medical Student Program Director at the Naval Medical Center Portsmouth, as well as a Lieutenant Commander in the US Navy Medical Corps. She received her medical degree from Tulane Medical School in 1994 and completed her radiology residency at the National Capital Consortium in 2003. She is certified by the American Board of Radiology and has been appointed Adjunct Assistant Professor of Radiology and Radiological Sciences at the F. Edward Hébert School of Medicine.

Case report
A 35-year-old man presented to the emergency department with a 24-hour history of periumbilical abdominal pain and associated nausea and vomiting. At presentation his vital signs were stable. He was noted to be tender over his right lower quadrant without frank peritoneal signs. Laboratory analysis found an elevated white blood count (WBC) of 16.7 X 10³/µL (normal, 4.5–10.8) and was positive for occult fecal blood.

An acute abdominal series was performed (Figure 1). Given the abnormal appearance of the small bowel and the peripherally calcified stones overlying the pelvis (Figure 2), contrast-enhanced computerized tomography (CECT) was performed to "rule out appendicitis" (Figure 3).

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