Xanthogranulomatous appendicitis (XGA) is a rare process affecting the appendix vermiformis. Due to the atypical presentation of XGA, it is most commonly diagnosed post operatively on surgical pathology and is associated with interval appendectomies. Here, we describe a rare case of XGA diagnosed on pathology after acute appendicitis was found on routine Positron emission tomography scan for a minimally symptomatic patient with stage IV adenocarcinoma of the lung. Further prospective studies are required to evaluate the atypical presentation of XGA and the use of interval appendectomies following acute appendicitis diagnosis.
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