This 5 y/o male presented with loss of appetite and abdominal pain for 24 hours. There was moderate abdominal tenderness without rebound or localization, temp - 99.8 °F, WBC count - 10,600 /mm³, Polys - 80, bands - 3, Lymphs - 15, Eos - 2. The KUB and selected ultrasound images from the RLQ shown above demonstrate a calcified appendicolith. The appendix is enlarged with thickening of it's wall. The findings are consistent with acute appendicitis. By the following morning, the patient's temperature had risen to 101 °F and his WBC count to 12,000 /mm³. An acutely inflamed, swollen, suppurative, appendix was removed surgically. Is sonography or CT the preferred initial imaging technique in patients with right lower quadrant pain of uncertain etiology? The answer to this question depends on the clinical circumstances of each case. Review of the first two references below may help guide your selection of the initial imaging modality. For an example of early appendicitis on CT see the case of the week: May 11, 1998 - Acute Appendicitis - CT Scan. The value of WBC scanning in children is not clear at this time.(13, 14) The improvement of CT and sonographic techniques has nearly eliminated the use of the contrast enema in the diagnosis of right lower quadrant pain.