0:01

So CT isn't the only modality that is

0:03

useful in diagnosing acute appendicitis.

0:06

In children, in particular, there are

0:08

special concerns and considerations that

0:10

need to be kept in mind, particularly the

0:12

radiation that can come with a CT scan

0:14

and the fact that they need to stay still

0:16

for a CT scan to help keep it diagnostic.

0:18

So ultrasound is a good next-choice modality.

0:21

In this case, what you're looking for

0:23

is the same thing that you see on CT.

0:25

You're looking for a blind-ending tube.

0:28

And in this case, if it's acute appendicitis,

0:30

you do the slow graded compression,

0:32

which is pushing on the ultrasound probe

0:34

itself to see if you can squish it.

0:37

For ultrasound, a normal appendix diameter

0:39

is less than six millimeters when compressed.

0:42

So here's an example of an

0:43

ultrasound using a nonlinear probe.

0:45

We have this blind-ending tube

0:47

right here that has bowel signature

0:49

that's present in the right lower quadrant.

0:52

So as we go through this, we see an

0:53

echogenic focus down here at the tip and a

0:55

little bit of vascularity, which is normal.

0:56

This may represent an appendicitis,

0:58

but in this case, since it's at the

1:00

tip, it would not be an obstructing one.

1:01

It would just be an appendicitis

1:03

that happens to be there.

1:04

We do see some color Doppler vascularity in

1:06

this structure, and again, which is normal.

1:09

Um, particularly when you have an

1:10

acute appendicitis, you have a lot of

1:12

inflammation, increased vascularity.

1:14

So seeing doppler flow is

1:15

a normal expected finding.

1:17

Same thing with power Doppler here.

1:19

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.

1:24

And since it is in the right lower

1:25

quadrant, it's a blind-ending tubular

1:27

structure with bowel signature.

1:29

This is an example of an acute appendicitis.

1:33

Other things that you can look for with

1:34

ultrasound are discontinuous

1:36

wall, echogenic inflamed fat

1:39

adjacent to the appendix, a fluid collection,

1:42

or you can look for free air or gas.

1:45

So here are your transverse images

1:46

again, where you can see a thick-walled

1:48

structure right here, a little bit of

1:50

fluid in the lumen, which is normal.

1:52

And if you measure this, it would

1:53

be greater than six millimeters.

1:57

So an example here of doing the compressions,

1:59

we have a cine clip here where the

2:02

sonographer was trying to push on it.

2:04

And during this push in the sagittal

2:06

plane, it really doesn't move very much.

2:08

It certainly doesn't compress.

2:09

It moves a little bit with

2:10

the patient's breathing.

2:11

You can see the rectus muscles moving.

2:14

But the appendix itself doesn't compress.

2:15

Here's the same thing, but in a transverse view.

2:21

The appendix itself never compresses.

2:23

In bowel, you can usually compress and move gas

2:25

away to make the structure a little bit thinner.

2:27

In acute appendicitis, because it

2:29

is obstructed, you cannot do that.

2:31

It won't change diameter.