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Acute Appendicitis US

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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.

1:22

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.

Report

Faculty

Kathryn McGillen, MD

Assistant Professor of Radiology, Medical Director of Ultrasound

Penn State University Milton S Hershey Medical Center

Tags

Ultrasound

Infectious

Gastrointestinal (GI)

Body

Appendix

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