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Acute appendicitis

Acute appendicitis ultrasound case study

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Acute appendicitis ultrasound case study

CASE–1

Clinical History

A 24-year-old patient presented with acute right lower quadrant abdominal pain, fever, nausea, vomiting, and loss of appetite. On clinical examination, there was localized tenderness at McBurney's point with guarding. The patient was referred for abdominal ultrasound to evaluate suspected acute appendicitis.

Ultrasound Findings

Ultrasound examination demonstrates a blind-ending, non-compressible tubular structure arising from the cecum in the right iliac fossa measuring approximately 8.5 mm in maximal outer diameter. The appendiceal wall is thickened with preserved mural stratification. Increased periappendiceal echogenic fat is noted, consistent with surrounding inflammatory changes. Color Doppler demonstrates increased mural vascularity (hyperemia). A small amount of periappendiceal free fluid is present. No appendicolith, periappendiceal abscess, perforation, or phlegmon is identified.

Ultrasound of the right iliac fossa. A non-compressible blind-ending tubular structure measuring greater than 6 mm with periappendiceal inflammatory fat changes and increased Color Doppler vascularity is demonstrated, consistent with acute appendicitis.

Report Line

A blind-ending, non-compressible tubular structure arising from the cecum measures approximately 8.5 mm in maximal diameter with mural thickening and increased Color Doppler vascularity. Mild periappendiceal inflammatory fat changes and a small amount of adjacent free fluid are present. No appendicolith, periappendiceal abscess, perforation, or phlegmon is identified. Sonographic findings are consistent with acute uncomplicated appendicitis.

Impression

Features are consistent with acute uncomplicated appendicitis with associated mild periappendiceal inflammatory changes. No sonographic evidence of perforation or periappendiceal abscess.

Recommendation

Urgent surgical consultation is recommended. Correlation with clinical findings and laboratory investigations (CBC, CRP, and inflammatory markers) is advised. If ultrasound findings are equivocal or complications are suspected, contrast-enhanced CT abdomen and pelvis (or MRI in pregnancy) should be considered for further evaluation. Prompt surgical management should be guided by the treating surgeon.

Key Learning Points

The normal appendix measures ≤6 mm in maximal outer diameter and is compressible.
Acute appendicitis typically appears as a non-compressible blind-ending tubular structure measuring >6 mm.
Increased periappendiceal fat echogenicity and Color Doppler hyperemia are important secondary signs of inflammation.
An appendicolith appears as an echogenic focus with posterior acoustic shadowing and increases the risk of perforation.
Periappendiceal fluid, abscess, phlegmon, or loss of mural integrity suggests complicated appendicitis.
Ultrasound is the preferred first-line imaging modality in children, young adults, and pregnant patients.
CT abdomen has the highest diagnostic accuracy when ultrasound findings are inconclusive or complications are suspected.