Unusual Pneumonia Mimic

  • Joana Ricardo Pires Internal Medicine Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
  • Maria José Moreira Internal Medicine Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
  • Margarida Martins General Surgery Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
  • Clarinda Neves Internal Medicine Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal


Appendicitis, subhepatic appendix, sepsis, inflammatory lung injury


Disease in atypical organ locations can mimic other pathologies, hampering the right diagnosis. Such conditions may even be emergencies, like appendicitis. Subhepatic appendix is a very rare entity which may be caused by caecum dehiscence failure. The authors present the case of a 55-year-old immunocompetent man admitted to the Emergency Department with sepsis and severe hypoxaemia. Chest x-ray showed right lower lobe infiltrate, and community-acquired pneumonia was diagnosed. The patient was started on broad-spectrum antibiotics, but he continued to deteriorate and after 3 days developed abdominal complaints. Exploratory laparoscopy revealed an abscess caused by perforated subhepatic appendicitis.
Subhepatic appendicitis presents a diagnostic challenge and its clinical presentation may mimic that of other entities. This case highlights an atypical presentation, where the early development of inflammatory lung injury mimicked common pneumonia. Maintenance of a high index of suspicion and knowledge of these atypical locations is crucial.



  • Rappaport WD, Warneke JA. Subhepatic appendicitis. Am Fam Physician 1989;39:146–148.

  • Palanivelu C, Rangarajan M, John SJ, Senthilkumar R, Madhankumar MV. Laparoscopic appendectomy for appendicitis in uncommon situations: the advantages of a tailored approach. Singapore Med J 2007;48:737–740.

  • Vasquez-Rios G, Calixto-Aguilar L, Pajuelo R, Alarcon W. Thoracic empyema as rare complication of an appendicular mass: a case study and review of the literature. Case Rep Pediatr 2018;2018:1–6.

  • Neumann B, Zantl N, Veihelmann A, Emmanuilidis K, Pfeffer K, Heidecke C-D, et al. Mechanisms of acute inflammatory lung injury induced by abdominal sepsis. Int Immunol 1999;11:217–227.
  • Published: 2019-07-17

    Issue: Vol 6 No 7 (view)

    Section: Articles

    How to cite:
    Ricardo Pires J, Moreira MJ, Martins M, Neves C. Unusual Pneumonia Mimic. EJCRIM [Internet]. 2019Jul.17 [cited 2020Sep.18];6(7). Available from: https://ejcrim.com/index.php/EJCRIM/article/view/1181

    Similar Articles

    You may also start an advanced similarity search for this article.

    Most read articles by the same author(s)