SONOWORLD : Appendicitis, Right Lower Abdominal Pain

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Abdomen » Appendix

Acute Appendicitis

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Author(s) :

Ross Wank, MD

Rafay Ahmed, MD

Presentation 15 year old female with right lower quadrant pain and low grade temperature. On physical exam there was tenderness in the right lower quadrant, with rigidity and guarding.

Caption: Sonogram of Right Lower Quadrant

Description: Right Lower Quadrant sonogram at the site of maximum tenderness shows a tubular, fluid filled, distended, non-compressible structure. The wall is 2mm thick and total appendix diameter is 10mm.

Caption: Short-Axis View of Appendix with color Doppler

Description: Short-axis view of appendix with color Doppler showing moderate flow in the appendiceal wall.

Caption: Long-Axis View of Appendix.

Description: This long-axis view shows a thick walled non- compressible blind ending tubular structure.

Differential Diagnosis Acute Appendicitis
Ovarian Torsion
Right Ureteric Calculus

Final Diagnosis Acute Appendicits

Discussion Sonographic Signs of Appendicitis (1) :

Primary finding:

Appendix diameter > 6mm.

Other findings :

Lack of compressibility
Inflamed, echogenic periappendiceal fat
Hyperemia on color Doppler
Appendicolith
Adjacent fluid collections

For a more detailed discussion about the relative frequency of occurrence of each of the above findings see web resource
http://www.meddean.luc.edu/Lumen/MedEd/Radio/Nuc_med/Appendicitis/ultrasou.htm

Case References Ultrasound: The Requisites, Second Edition (Requisites in Radiology) 2nd Edition by William D. Middleton, Alfred B. Kurtz ISBN-13: 978-0323017022

Follow Up Surgery confirmed acute appendicitis.

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