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A 70-year-old man with a history of peripheral T-cell lymphoma in complete remission since 2012, presented with a three-week history of a tender ‘knot’ in his right inguinal/suprapubic region. He denied fevers, nausea, vomiting, and constipation. Physical examination was remarkable only for a 4x5 cm firm mass in the right suprapubic region. Complete blood counts and a comprehensive metabolic panel were normal except for a chronically elevated creatinine (1.9 mg/dL) and mildly elevated lactate dehydrogenase (279 units/L). Transaxial (Figure 1A) and coronal (Figure 1B) computed tomography (CT) images, obtained without intravenous contrast, revealed marked appendiceal thickening (arrows) and periappendiceal fat-stranding (arrowheads), suspicious for acute appendicitis. As shown in Figure 1B, the appendix was located within an indirect inguinal hernia sac (bracket), an entity known as an Amyand hernia. There was no evidence of appendiceal perforation. One day later, the patient underwent a laparoscopic appendectomy and open primary right inguinal hernia repair with a post-operative diagnosis of “acute, perforated appendicitis incarcerated within an indirect right inguinal hernia.” In addition to acute-

Apparent appendicitis in Amyand hernia with unexpected pathology