IOTW 08-17-2020

Case

26 y/o male presents with abdominal pain and emesis. RLQ POCUS performed as below.

What do you think?

Clip1Clip3clip2

  • What is the diagnosis? Acute appendicitis without rupture
  • What are the sonographic landmarks
    for performing this exam?
    RLQ and point of maximal tenderness; must visualize iliac vessels and psoas muscle
  • What are the sonographic “hard” signs
    of a positive exam?
    Non-compressible, non-peristaltic, avascular blind-ended tubular structure traceable to cecum measuring >6 mm
  • What are the sonographic “soft” signs? Appendicolith, RLQ free fluid, periappendiceal fat stranding (increased echogenicity), “Ring of Fire” (increased peripheral vascularity), enlarged mesenteric lymph nodes

Note that appendix may be compressible if it is ruptured!

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s