This 57 y/o female presented with diffuse lower abdominal pain without rebound. WBC count was normal. Urinalysis showed 2-4 WBCs/hpf. Ultrasound of the pelvis and right lower quadrant were normal. A CT scan was performed. The selected images shown above demonstrate an enlarged appendix with wall enhancement and mild surrounding inflammatory change consistent with appendicitis. An acutely inflamed appendix was removed at surgery. Is CT with or without oral or IV contrast or sonography the best test? For a good review see the first article below.(1.) In some more obscure cases HMPAO White Blood Cell scanning may be helpful. (see: Sept 29, 1997 - Appendicitis - Tc-99m HMPAO Labeled WBC Scan). Is the contrast enema dead for diagnosing appendicitis? Probably, but intelligent clinical judgement should guide the selection of any diagnostic test. In most patients with acute appendicitis, an accurate diagnosis will be established by history, physical examination, and simple laboratory tests. Curative surgery should then be performed without resorting to further expensive, probably unnecessary, potentionally dangerous, diagnostic studies.