Presentation
Right-sided abdominal pain for the last two weeks. Treated conservatively for acute appendicitis
Patient Data
A short subhepatic appendix with tip directed to 12 o'clock. The appendix shows a loss of gut signature sign. There are at least three focal areas showing a full-thickness breach of the wall. It is seen as echogenic periappendiceal fat communicating with the appendicular lumen. Few air foci are present in the lumen. Inflammed peri-appendiceal fat without local nodes/ collection. Hypoechoic thickening of the hepatic parietal peritoneum where the appendix tip touches it.
Cine-loop aligned to the appendicular short-axis runs in the craniocaudal direction (from the appendicular tip to the base).
Cine-loop aligned to the appendicular short-axis runs in the craniocaudal direction (from the appendicular tip to the base). The appendix is indicated as 'appx'.
Case Discussion
The patient developed right-sided abdominal pain 2 weeks ago. He was diagnosed (somewhere else) and treated conservatively for acute appendicitis. This ultrasound was done for persistent low-grade pain in the right side of the abdomen.
The ultrasound shows multiple appendicular perforations, loss of gut signature sign, and periappendiceal inflammation. Inflammed fat allows a very good evaluation of the appendix as a contrast is generated. It makes radiologists' work easy but makes surgeons' work difficult.
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