Appendix Ultrasound

The small organ that can cause big trouble.
The vermiform (worm like) appendix is a finger-like projection off of the base of the cecum, it can become inflamed and require surgical removal.
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Appendicitis
 
Symptoms:
  • mid abdomen to RLQ pain
  • rebound tenderness
  • nausea, diarrhea or vomiting
  • elevated white blood cells (not always)
  • pain when walking or lifting right leg)
 
Scanning:
Use a linear probe 7-9 mHz. Try others if difficult to image patient.
Patients are scanned in supine and left lateral decubitus. Start at the RUQ image the Liver, RT Kidney and Gallbladder, sometimes the appendix may be tucked up there. Ask patient where maximum point of pain is. The normal location of the appendix is usually McBurney’s point (halfway between anterior iliac spine and umbilicus)
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Use guided compression of the ascending colon down to the cecum
appendix can vary in location and be behind the cecum (retrocecal), deep in the pelvis, behind the bladder, draped over the iliac vessels, in the RUQ, midline near spine.
 
Normal Appendix:
-< 0.6 cm
-compressible
-may contain air bubbles or fluid
-is smooth does not contain haustra (sacular folds of the colon)

                                      Normal Appendix

 

 
Positive Appendix:
-> 0.6 cm
-hyperemic (increased blood flow on doppler indicative of inflammation)
-non-compressible
-free fluid (may be present in normal, if complex or debris filled in the presence of appendicitis consider rupture

                       Positive Appendiceal Ultrasound

                                Ruptured Appendicitis

Henry Suarez RDMS, RVT
Image sources
Further Reading:
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