Replies to This Discussion

Permalink Reply by Bashir H Samma;MD,PGD&C,SrMAIUM on December 28, 2010 at 4:29pm

One may visualise the appendix, but it is not sonographically inflamed, and does not tally with history, clinical findings, together with local tenderness on careful focal compression, then personally I consider it as a coincidence.

However some customers may have already taken antibiotics and NSAID that may mask the clinical picture. When I see fecalith, i usually take seriously,

Hope this helps

Permalink Reply by Syed Amir Gilani on January 30, 2011 at 9:48am

GREAT.

Permalink Reply by geri clausen on February 16, 2011 at 11:31am

I work for several different hospitals in my region with a collective agreement on US appendix protocol.  Yes, aim for the visualilzation of a normal appendix. Also we will include images of Rt/Lt adnexa, and RUQ/LUQ as well as RLQ mesentery for any lymph node enlargements.  Depending on the age of the patient, gender, amount of free fluid (if any)  and the experience level of the sonographer, if the appendix is not identified with confidence, a CT may be warranted.

Permalink Reply by Laura Burke on May 12, 2011 at 9:31am

We have been doing more and more appendix evaluations with u/s in my facility and it took quite awhile to get confident in doing them. The ER docs are pretty confident if we don't see an appendix and the pt. doesn't completely meet criteria that it isn't appendicitis.  If they are showing clinically w/ what appears to be appendicitis and we can't give them a definate answer, they will order a CT appendix protocol. 

Permalink Reply by Alexis Lopez Mendez on May 19, 2011 at 3:25pm

Thanks, very much. I need you send me pictures about it.appendix  US of course
Laura Burke said:

We have been doing more and more appendix evaluations with u/s in my facility and it took quite awhile to get confident in doing them. The ER docs are pretty confident if we don't see an appendix and the pt. doesn't completely meet criteria that it isn't appendicitis.  If they are showing clinically w/ what appears to be appendicitis and we can't give them a definate answer, they will order a CT appendix protocol. 

Permalink Reply by Bashir H Samma;MD,PGD&C,SrMAIUM on April 12, 2012 at 4:13pm

This is rather a late reply. But the best way to sonographically diagnose appendicitis is to interorogate the point of maximal tenderness, and perform a graded compression study. If there is an inflammation in the RIF, there should be some structural changes and the "blind-ending" vermiform structure may be apparent. I think a "pink appendicitis" or one dampened by prior antibiotic and NSAID therapy may not be classical in appearance. If do not visualize the appendix with a good graded compression to frive away bowel gas, then appendicular inflammation is unlikely. This does not apply to a retrocecal appendix, whose tip may be located upper in the right flank.

 

Permalink Reply by Bashir H Samma;MD,PGD&C,SrMAIUM on April 12, 2012 at 4:21pm

Sometimes there is no Pin-point site of tenderness, like this one below, with caption....

Attachments:

• appendicitis fecalith caption2.tif, 197 KB