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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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