No urinary signs or symptoms were found. The psoas sign and obturator sign were both positive. Physical examination of abdomen revealed no tenderness, but there was pain in the lower right quadrant and McBurney��s point. Chest and abdominal X-rays were normal; WBC count was 16,000/mm3. Biochemistry profile showed only moderately low ionized calcium and blood iron. US revealed a suspected selleckchem left ovarian cyst. For this reason the patient underwent a transvaginal ultrasound, that was negative for gynecological disorders. A CT scan was performed to clarify the diagnosis, and revealed a lesion on the right femoral neck known as herniation pit. The patient was treated with anti-inflammatory therapy and all symptoms had completely disappeared 3 days after admission.

She was admitted to an orthopedic ward and was discharged 2 days later without any pain and in good general conditions. She was prescribed anti-inflammatory therapy for 10 days and recommended to reduce her physical activity and return for regular follow-up examinations. Six months later, her condition is still good. Discussion The rate of negative appendectomies, defined as the removal of a non-inflamed appendix, remains high (15�C25%). The general problem and incidence, as well as the influence of modern diagnostic techniques on the rate of negative appendectomies, are of particular clinical importance. The risk of overtreatment in the reduction of the negative appendectomy rate could lead to acceptance of a higher perforation rate. Moreover, diagnosis of acute appendicitis in young women can be difficult, as many signs and symptoms are non-sensitive and non-specific.

Acute appendicitis in females may be confused with numerous conditions causing acute pelvic pain. In fact, multiple studies have shown that 20 to 50 percent of women presenting with pelvic pain have pelvic inflammatory disease (PID), sometimes caused by ruptured ovarian cysts (8). Although this is an easily reached diagnosis in most cases, its presentation is not always typical and there are other conditions which may mimic appendicitis. Although CT has a higher diagnostic accuracy, ultrasound is safe, easily accessible and, above all, does not use ionizing radiation. For these reasons, we believe that US should be the primary investigation for all patients with suspected appendicitis, as also suggested by other investigators (9).

In our patient HP mimicked an acute appendicitis. How can this happen? Herniation pits of the femoral neck are caused by mechanical stress from Anacetrapib the overlying joint capsule and iliopsoas tendon, and consist of a small opening in the anterior surface of the femoral neck through which fibrous and cartilaginous elements infiltrate the cortex through a perforation. They are usually asymptomatic and generally considered an incidental radiological finding (7,10).