An Unusual Cause of Abdominal Pain in an 8-year-old Girl

An eight-year-old girl presented with a history of fever, nonbilious vomiting, and abdominal pain lasting three days. She was referred from a peripheral hospital for suspected acute appendicitis and admitted to the pediatric emergency department. She had difficulty breathing and pain in the left side of the chest referred to the back. On examination, her vitals were stable with oxygen saturation of 92% in room air. Abdominal examination revealed diffuse tenderness without guarding or rebound tenderness. Chest auscultation showed reduced breath sounds on left-sided posterior lung fields. She was subjected to an erect chest X-ray [Figure 1] and abdominal ultrasound