Diagnose acute appendicitis: ultrasound

Normal appendix:

Longitudinal real-time US scan of a normal appendix. Diameter

0.3 cm. ** psoas muscle, * rectus muscle, x caecum, + terminal
ileum
Diagnose acute appendicitis: ultrasound
Normal appendix:

Normal appendix, longitudinal scan (tubular Normal appendix, transverse scan (ovoid
blind-ending structure with laminal layer laminal layer structure)
structure)
Sonographic findings for appendicitis:
1. Blind ended finger like structure with lack of
peristalsis
2. Diameter > 6 mm
 Sonographic findings for appendicitis:

Longitudinal (a) and transverse (b) real-time US scan of acute appendicitis with thickening of the wall (crosses 2),
target–sign, diameter > 6 mm (crosses 1) and free fluid surrounding the appendix (+)
Sonographic findings for appendicitis:
3. Non-compressible under pressure > 5mm
4. Periappendiceal fluid is suggestive of inflammation
Sonographic findings for appendicitis:
5. Appendicolith maybe visualized

Acute appendicitis with fluid, appendicolite with posterior acoustic

shadow and echogenic submucosa absence at the tip of the
appendix due to necrosis.
Ultrasound
Advantage
- Widely available and inexpensive
- Avoidance of ionizing and radiation:
Especially women of reproductive age and children
Gynecological disease gives further for reason for U/S evaluation
Disadvantage
- Operator dependent
Ultrasound
The causes of false positive or false negative results at U/S
False positive
• hydrosalpings
• mucocele with pseudomyxoma peritonei in small quantity
• terminal ileum segmental necrosis
• Meckel’s diverticulitis
• cecal diverticulitis
• ovarian torsion
False negative
• obesity
• appendix point position
• difficulties in practicing graded compression
• pain absence at compression in right lower quadrant
References
1. Mostbeck.M., Adam.E.J., Nielsen.M.B. et al. How to diagnose acute appendicitis: ultrasound first. Insights
Imaging. 2016;7:255–263.
2. Moş.M., Ile.T., Hălbac.M., Chiş.L. et al. Ultrasonographic diagnosis of acute appendicitis. Medical
Ultrasonography. 2009;11(3):7–18.
3. Janitz.E., Naffaa.L., Rubin.M.S., Ganapathy.S. Ultrasound evaluation for appendicitis
focus on the pediatric population: A review of the literature. J Am Osteopath Coll Radiol. 2016;5(1).