Interactive Transcript
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So CT isn't the only modality that is
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useful in diagnosing acute appendicitis.
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In children, in particular, there are
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special concerns and considerations that
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need to be kept in mind, particularly the
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radiation that can come with a CT scan
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and the fact that they need to stay still
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for a CT scan to help keep it diagnostic.
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So ultrasound is a good next-choice modality.
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In this case, what you're looking for
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is the same thing that you see on CT.
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You're looking for a blind-ending tube.
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And in this case, if it's acute appendicitis,
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you do the slow graded compression,
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which is pushing on the ultrasound probe
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itself to see if you can squish it.
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For ultrasound, a normal appendix diameter
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is less than six millimeters when compressed.
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So here's an example of an
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ultrasound using a nonlinear probe.
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We have this blind-ending tube
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right here that has bowel signature
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that's present in the right lower quadrant.
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So as we go through this, we see an
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echogenic focus down here at the tip and a
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little bit of vascularity, which is normal.
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This may represent an appendicitis,
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but in this case, since it's at the
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tip, it would not be an obstructing one.
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It would just be an appendicitis
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that happens to be there.
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We do see some color Doppler vascularity in
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this structure, and again, which is normal.
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Um, particularly when you have an
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acute appendicitis, you have a lot of
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inflammation, increased vascularity.
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So seeing doppler flow is
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a normal expected finding.
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Same thing with power Doppler here.
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And if we measured here, this one measured 1.9 cm.
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42 00:01:23,164 --> 00:01:24,225 This is too thick.
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And since it is in the right lower
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quadrant, it's a blind-ending tubular
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structure with bowel signature.
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This is an example of an acute appendicitis.
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Other things that you can look for with
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ultrasound are discontinuous
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wall, echogenic inflamed fat
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adjacent to the appendix, a fluid collection,
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or you can look for free air or gas.
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So here are your transverse images
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again, where you can see a thick-walled
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structure right here, a little bit of
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fluid in the lumen, which is normal.
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And if you measure this, it would
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be greater than six millimeters.
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So an example here of doing the compressions,
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we have a cine clip here where the
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sonographer was trying to push on it.
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And during this push in the sagittal
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plane, it really doesn't move very much.
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It certainly doesn't compress.
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It moves a little bit with
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the patient's breathing.
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You can see the rectus muscles moving.
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But the appendix itself doesn't compress.
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Here's the same thing, but in a transverse view.
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The appendix itself never compresses.
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In bowel, you can usually compress and move gas
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away to make the structure a little bit thinner.
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In acute appendicitis, because it
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is obstructed, you cannot do that.
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It won't change diameter.
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