As ultrasound involves no ionizing radiation and is a better
modality for gynecologic conditions, it is recommended as the initial imaging
modality in chidren, young women and during pregnancy. It has very high
sensitivity and specificity for diagnosing appendicitis.
compression technique described by Puylaert
is standard method for US evaluation of acute appendicitis. Slow, gentle
maintained pressure at maximum point of pain and tenderness helps to
demonstrate appendix easily. If patient is not allowing to compress, we can use
Baldisserotto’s technique of changing patients position to
displace bowel loops. It is very important to localize cecum which helps as a
guide in search for appendix.
In this case both techniques were used as the patient was
obese. Turning patient to left lateral position immediately demonstrated
Dilatation of appendix more than 6mm, surrounding fluid and enlarged lymphnodes confirmas the diagnosis of appendicitis. Patient also experiences severe probe tenderness on performing US.