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Advanced radiological imaging has largely replaced exploratory operations and has become an essential diagnostic tool clinicians routinely rely on. However, physicians are faced with a lot of radiological findings without histological proof, and assuming a more serious diagnosis may lead to unnecessary investigations and emotional stress for patients. We report an unusual presentation of chronic appendicitis with a synchronous peritoneal nodule on CT in a 76-year-old woman who presented with poor appetite, weight loss and a mass in the right iliac fossa. The coincidental finding of the nodule in addition to the suspicious appearance of the appendix raised concerns for primary appendiceal cancer with peritoneal metastasis. The case illustrates the patient's management and reflects on the learnt lessons with regard to careful use of invasive radiology-guided biopsies and interval imaging, as these could sometimes delay the diagnosis and management of a readily treatable disease.

Chronic inflammation masquerading as an appendiceal tumour with peritoneal metastasis: the challenge of diagnosis and the lessons learnt