Presentation
Right iliac fossa pain. No significant past medical history.
Patient Data
Probe is positioned over the right lower abdomen in a transverse orientation.
The cine loop demonstrates a non-preinstalling, blind-ending tubular structure arising from the cecum (the clip starts from the structure's tip and is followed as it joins into the cecum in the last few images).
There is increased reflectivity surrounding the structure (fat wrapping)
The ultrasound images show that the tubular structure measures 9.9mm in thickness and there is minimal increased associated color flow (last image).
Once again there is surrounding fat wrapping and the structure is incompressible (middle image showing appearances before and after applying increased pressure with the ultrasound probe)
Case Discussion
The ultrasound appearances are diagnostic for acute appendicitis, as evidenced by a tubular structure arising from the cecum which was blind-ending and non-compressible, measuring nearly 1cm in thickness and with surrounding fat wrapping. There was point tenderness while scanning.
The patient was taken to the theater a few hours after the ultrasound scan and the op note described:
"...Findings
RIF inflamed appendix
The middle segment of the appendix adherent retroperitoneally to the external iliac arteries
Mid-ascending colon adherent to the roof of the abdomen
...
Appendix cut in between and removed via Endocatch..."
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