Ultrasonography of appendicitis
Author:
Mikael Häggström [notes 1]
Contents
Choice of exam
- Ultrasonography is the first choice of exam. In children, it gives a proper diagnosis in the vast majority even in obese children.[1] In adults, it is often inconclusive, but is still recommended as a first imaging choice when symptoms indicate the condition.[2] If inconclusive, further evaluation can be done by reassessment by the clinician, as well as complementary imaging with MRI or CT.[2]
Findings
File:UOTW 45 - Ultrasound of the Week 3.jpg
Ultrasound showing appendicitis and an appendicolith[3]
File:Ultrasonography of a normal appendix, annotated.jpg
Ultrasound of a normal appendix for comparison
File:Ultrasonography of a normal appendix without and with compression.jpg
A normal appendix without and with compression. Absence of comprehensibility indicates appendicitis.[4]
Findings indicating appendicitis:
- Absence of compressibility[5]
- Dilatation >6 mm in outer diameter[5]
- Appendicolith[5]
- Distinct wall layers[5]
- Hyperechoic and prominent periappendiceal and pericecal fat[5]
- Periappendiceal fluid[5]
- Target sign[5]
- Periappendiceal lymphadenopathy[5]
Report
- Location of the appendix is important when surgery may be needed. At least when atypically located, the description should include both area in relation to surface landmarks, as well as relation to internal structures, particularly the cecum.
- Findings as per above, or negation of signs of appendicitis.
- Presence/Absence of ascites or any visible lymphadenopathy, also helpful in differential diagnosis
References
- ↑ George A Taylor, David E Wesson. Acute appendicitis in children: Diagnostic imaging. UpToDate. Retrieved on 2018-06-25. Last updated Apr 30, 2018
- ↑ 2.0 2.1 Mostbeck, Gerhard; Adam, E. Jane; Nielsen, Michael Bachmann; Claudon, Michel; Clevert, Dirk; Nicolau, Carlos; Nyhsen, Christiane; Owens, Catherine M. (2016). "How to diagnose acute appendicitis: ultrasound first ". Insights into Imaging 7 (2): 255–263. doi:. ISSN 1869-4101.
- ↑ . UOTW #45 - Ultrasound of the Week. Ultrasound of the Week (25 April 2015). Archived from the original on 9 May 2017.
- ↑ Reddan, Tristan; Corness, Jonathan; Mengersen, Kerrie; Harden, Fiona (March 2016). "Ultrasound of paediatric appendicitis and its secondary sonographic signs: providing a more meaningful finding ". Journal of Medical Radiation Sciences 63 (1): 59–66. doi:.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 Dan J Bell and Koshy Jacob. Appendicitis. Radiopaedia. Retrieved on 2018-06-25.
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