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APPENDIX ACUTE APPENDICITIS
Category: Diagnostic Radiology
Abstract : Appendix Acute appendicitis is a common diagnosis on admission to the
casualty department with right lower abdominal pain. However around 15–25% of
patients who undergo laparotomy turn out to have normal appendices. The use of
ultrasound in the investigation of acute abdominal pain is well established and
can increase the reliability of the diagnosis of acute appendicitis when
p
Appendix
Acute appendicitis is a common diagnosis on admission to the
casualty department with right lower abdominal pain. However around 15–25% of
patients who undergo laparotomy turn out to have normal appendices. The use of
ultrasound in the investigation of acute abdominal pain is well established and
can increase the reliability of the diagnosis of acute appendicitis when
performed by an experienced operator.
The normal appendix is difficult to
locate. A high-frequency (7 MHz or more) linear or curved array probe is useful.
Gentle, graduated compression may move overlying bowel. Raising the patient’s
left side may encourage bowel gas to move away from the area of interest. The
normal appendix is compressible by gentle transducer pressure, which is usually
well tolerated by the patient.
The ultrasound features of acute
appendicitis include an enlarged, usually hypoechoic appendix greater than 6 mm
in diameter. The inflamed appendix is non-compressible. Attempted compression of
the acutely inflamed appendix obviously requires great care from the operator.
Compression must be very slow and the release of compression must be equally as
gentle. These features have a high sensitivity and specificity for acute
appendicitis (74% and 94% respectively). Acute appendicitis often demonstrates
hypervascularity on power Doppler.
Other causes for right iliac fassa
masses in patients presenting with pain include inflamed diverticula in patients
with diverticulitis. Perforation of the appendix may result in a demonstrable
periappendiceal fluid collection, or free fluid plus or minus dilated loops of
non-peristaltic small bowel. The presence of an ill-defined fluid mass in the
right iliac fossa of a symptomatic patient is highly suggestive of acute
appendicitis with perforation. This may become infected, leading to peritonitis.
Occasionally, a hyper-reflective appendicolith may be seen in the blind end of
the inflamed appendix, casting an acoustic shadow.
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