Presentation
An elderly man complains of right lower quadrant pain for 6 hours.
Patient Data
Age: 85 years
Gender: Male
From the case:
Acute appendicitis
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Real time ultrasound reveals non compressibility of the appendix with a 9 mm of diameter and fat stranding surrounding the appendix. An appendicolith is noted.
Case Discussion
Real-time ultrasound signs of acute appendicitis
- Direct signs
- Non-compressibility of the appendix (perforation: appendix might be compressible)
- Diameter of the appendix > 6 mm
- Single wall thickness ≥ 3 mm
- Target sign: hypoechoic (fluid-filled lumen), hyperechoic (mucosa/submucosa), hypoechoic (muscularis layer)
- Appendicolith: hyperechoic with posterior shadowing
- Color Doppler and contrast-enhanced US: hypervascularity in early stages of AA, hypo- to avascularity in abscess and necrosis
2. Indirect signs
- Free fluid surrounding appendix
- Local abscess formation
- Increased echogenicity of local mesenteric fat
- Enlarged local mesenteric lymph nodes
- Thickening of the peritoneum
- Signs of secondary small bowel obstruction
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