ULTRASOUND IMAGES OF Acute appendicitis

Acute appendicitis is a common diagnosis on admission to the casualty department with right lower abdominal pain. However around 15–25% of patients who undergo laparotomy turn out to have normal appendices. The use of ultrasound in the investigation of acute abdominal pain is well established and can increase the reliability of the diagnosis of acute appendicitis when performed by an experienced operator.
The normal appendix is difficult to locate. A high-frequency (7 MHz or more) linear or curved array probe is useful. Gentle, graduated compression may move overlying bowel. Raising the patient’s left side may encourage bowel gas to move away from the area of interest. The normal appendix is compressible by gentle transducer pressure, which is usually well tolerated by the patient. The ultrasound features of acute appendicitis include an enlarged, usually hypoechoic appendix greater than 6 mm in diameter. The inflamed appendix is non-compressible. Attempted compression of the acutely inflamed appendix obviously requires great care from the operator. Compression must be very slow and the release of compression must be equally as gentle. These features appendicitis often demonstrates hypervascularity on power Doppler.
Other causes for right iliac fassa masses in patients presenting with pain include inflamed diverticula in patients with diverticulitis. Perforation of the appendix may result in a demonstrable periappendiceal fluid collection, or free fluid plus or minus dilated loops of non-peristaltic small bowel. The presence of an ill-defined fluid mass in the right iliac fossa of a symptomatic patient is highly suggestive of acute appendicitis
with perforation (Fig. Ultrasound images below). This may become infected, leading to peritonitis. Occasionally, a hyper-reflective appendicolith may be seen in the blind end of the inflamed appendix, casting an acoustic shadow.

ultrasound images of Acute appendicitis with a thickened, tender wall and an abscess at the distal end.
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