IOTW 08-17-2020


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

What do you think?


  • 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!

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