Emergency Ultrasound Diagnosis of Acute Appendicitis

Abstract

A 6-year-old boy with no medical history presented to the emergency department with abdominal pain, vomiting, and anorexia that began 8 hours prior to arrival. Physical examination revealed abdominal tenderness in bilateral lower quadrants, but more pronounced on the right side. There were no peritoneal signs, and the genital exam was unremarkable. Laboratory analysis revealed a leukocytosis with a total white blood cell count of 17 × 109/μL, with a predominance of neutrophils. A focused right lower quadrant bedside ultrasound was performed by the treating emergency physician using a high-frequency linear transducer (Model XD11XE, Philips, Andover, MA). This demonstrated a noncompressible, blind-ending tubular structure in the right lower quadrant measuring 13 × 12 mm consistent with acute appendicitis (Figure 1 and Video Clip S1). The patient exhibited all of the accepted sonographic criteria for acute appendicitis: a noncompressible tubular blind-ending structure originating from the cecum, measuring >6 mm, and lacking peristalsis. Further investigation revealed increased flow within the appendiceal wall and surrounding hyperechoic fat suggesting an acute inflammatory process (Figure 2, Video Clip S2, and Video Clip S3). Surgical consultation was obtained and the child was admitted to the hospital for appendectomy. A transverse view of the inflamed appendix measuring 12 × 13 mm. Power Doppler demonstrates hyperemia within the appendiceal wall, suggesting acute inflammation. Longitudinal view of the appendix with surrounding hyperechoic fat (asterisks) suggesting an acute inflammatory process. Video Clip S1. Long-axis view of right lower quadrant demonstrates tubular, blind-ending, noncompressible structure. Video Clip S2. Color-power Doppler clip in long axis demonstrating hyperemia within the wall of the appendix. Video Clip S3. Color-power Doppler clip in short axis demonstrating hyperemia within the wall of the appendix. The video clips are in QuickTime. Please note: Wiley Periodicals Inc. is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing material) should be directed to the corresponding author for the article. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.