APPENDICITIS ULTRASOUND DIAGNOSIS
Category: Diagnostic Radiology
Abstract : Appendicitis Ultrasound is the first line of investigation for the child
presenting with acute abdominal pain, where the diagnosis is uncertain following
clinical assessment. The position of the appendix in small children may vary
pointing upwards, downwards or to the patients left making the clinical
diagnosis difficult, as the pain is not always confined to the right lower
quadr
Appendicitis
Ultrasound is the first line of investigation for the child
presenting with acute abdominal pain, where the diagnosis is uncertain following
clinical assessment. The position of the appendix in small children may vary
pointing upwards, downwards or to the patients left making the clinical
diagnosis difficult, as the pain is not always confined to the right lower
quadrant.
Ultrasound is particularly useful in establishing the diagnosis of
acute appendicitis and in diagnosing other possible causes of acute abdominal
pain, such as gynaecological disorders. It is always good practice to perform a
full abdominal survey when the clinical presentation is indeterminate.
Ultrasound demonstrates a hypoechoic, thickened appendix, > 6 mm thick,
with a blind end. Occasionally an appendicolith, with strong acoustic shadowing,
is present. The inflamed appendix is not compressible on gentle, graded
compression with the transducer. This should be done very carefully, and
released very slowly to avoid rebound tenderness.
Ultrasound cannot
reliably exclude appendicitis, especially if the appendix is retrocaecal.
Perforation may not be easy to see with ultrasound, as fluid may disperse
through the abdomen with decompression of the appendix itself. However, a frank
periappendiceal fluid collection or abscess is easily demonstrable in a
proportion of children and may, in some cases, be treated conservatively with
antibiotics or drained percutaneously prior to surgery.
The presence of
free fluid, particularly if clear, in the abdomen is a non-specific finding and
is not a reliable indicator of an acute abdomen. If echogenic fluid is seen,
this is suggestive of intraperitoneal infection in the child with acute
abdominal pain, but may be seen in other conditions, for example rupture of a
haemorrhagic ovarian cyst. If ultrasound is equivocal, the clinicians may decide
to observe the child but further imaging with CT scanning can be helpful in a
few selective cases. Alternatively a laparoscopic examination may be performed
where there is significant clinical concern.
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