This obese 49 y/o female presented with abdominal pain. On physical exam diffuse abdominal tenderness without rebound or localizing signs was noted. WBC count was normal. Urinalysis demonstrated 15 - 20 RBCs/hpf and 10-15 WBCs/hpf. IVP initially showed the right ureter to be more prominent than the left, however the post voiding film was unremarkable. A gastrograffin enema did not demonstrate any diverticula. Continuing abdominal pain led to CT scans of the abdomen and pelvis. Both were normal. Because of persistent abdominal pain and rising WBC count, despite the empirical administration of antibiotics, a Tc99m labeled WBC scan was performed. The abnormal right lower quadrant uptake was felt to be from appendicitis and the minimal renal excretion was presumed to be reactive urinary tract changes. The positive HMPAO WBC scan and increasing patient symptomatology led to laparotomy and appendectomy, confirming the diagnosis of suppurative appendicitis. While hexamethylpropylene amine oxime labeled WBC's may not be the primary imaging tool in the diagnosis of atypical abdominal pain, Tc99m HMPAO labeled WBC scans may occasionally be useful in the more obscure cases, as was demonstrated by this patient.