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Age: 7

Sex: Male

Indication: Right lower quadrant pain

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Case #12


Findings

  • Appendix is distended measuring up to 13 mm in diameter with mural thickening, periappendiceal edema, and a 12 mm appendicolith
  • No discrete adjacent fluid collection


Diagnosis

Acute appendicitis

Sample Report

Appendix is distended measuring up to 13 mm in diameter with mural thickening, periappendiceal edema, and a 12 mm appendicolith, concerning for acute appendicitis.

No discrete adjacent fluid collection to suggest abscess.


Discussion

  • When the appendix can be visualized in its entirety, ultrasound has strong sensitivity and specificity for acute appendicitis, making ultrasound a good initial diagnostic test, particularly in pediatric and thin adult patients
  • Remember that in order for the study to be diagnostic, the entire appendix needs to be visualized (including the tip). If the study is nondiagnostic and there is ongoing clinical concern, CT or MRI should be considered next
  • Ultrasound findings supportive of a diagnosis of acute appendicitis include:
    • Distension (> 6 mm in transverse diameter)
    • Wall thickening (single wall thickness > 3 mm)
    • Noncompressibility
    • Appendicolith
    • Periappendiceal edema/fluid


Images

Findings consistent with acute appendicitis including appendiceal distension (measuring 12 mm in diameter on this image), wall thickening, and a shadowing appendicolith (red arrows).

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