Appendicitis ultrasound

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Ultrasounds are a useful tool for diagnosing appendicitis. There are some limitations to the information provided by ultrasounds, such as sometimes ultrasonographic images of the iliac fossa show no abnormalities despite the presence of appendicitis. Whenever available, CT scans are preferred over ultrasounds for diagnosing appendicitis.

Appendicitis Ultrasound

• Ultrasound imaging presents the least amount of radiation and is therefore the investigation of choice for young patients. *It is the effective component in identifying abnormal appendixes, especially in thin patients.
• The ultrasound technique is known as graded compression, which uses linear probes over sites of maximal thickness and gradually increasing pressure exerted to displace normal overlying bowel gas.
• In some cases (approximately 15%), ultrasonography of the iliac fossa does not reveal any abnormalities despite the presence of appendicitis.
  • This is true of early appendicitis before the appendix has become significantly distended, especially in adults, where larger amounts of fat and bowel gas make actually seeing the appendix technically difficult.
• Despite these limitations, in experienced hands sonographic imaging can often distinguish between appendicitis and other diseases with very similar symptoms such as inflammation of the lymph nodes near the appendix or pain originating from other pelvic organs such as the ovaries or fallopian tubes.

Findings Supportive of Appendicitis

Findings that are supportive of the diagnosis of appendicitis include:

• Aperistaltic, noncompressible, dilated appendix (>6 mm outer diameter)
• Appendicolith
• Distinct appendieal wall layers
• Echogenic prominent pericaecal fat
• Periappeniceal fluid collection

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Appendicolith on ultrasound