Many pediatric patients presenting to the Emergency Department with acute abdomen are subject to one or even more than one imaging modalities in order to determine the reason for the patient's symptoms. Most of the times, imaging can render an accurate diagnosis and help clinicians and surgeons for the decision making plan and further management. In some circumstances, image findings are equivocal, non specific or simply misinterpreted and a correct diagnosis cannot been made preoperatively. Authors present a unique case of an unexpected acute appendicitis found during surgical exploration performed in order to remove an ovarian tumor in an eight-year-old girl.