Q: What should be considered in a male patient with right hypochondrial pain that starts as periumbilical and migrated to the right hypochondrial region, and with these ultrasonography findings: minimal subhepatic fluid collection with a bowel loop looking as in the images show answer
Patient presented with periumbilical pain that migrated to the right hypochondrium laterally at the same day of presentation.
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The subhepatic region revealing a non-compressible blind-ended distended aperistaltic tubular structure, showing positive probe tenderness sign on compression and a fecolith noted at its medial end. Minimal amount of fluid collection was noted around its tip and in the lateral subhepatic region.
Findings supportive of the diagnosis of appendicitis include 4:
- aperistaltic, noncompressible, dilated appendix (>6 mm outer diameter)
- distinct appendiceal wall layers
- echogenic prominent pericaecal fat
- periappendiceal fluid collection
- target appearance (axial section)
Confirming that the structure visualised is the appendix is clearly essential and requires demonstration of it being blind ending and arising from the base of the caecum.