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There was an article evaluating the NPV of US in the role of diagnosing acute appendicitis. We do very few ultrasounds for appendicitis at my facility. Do any of your sites require the visualization of a normal appendix to exclude acute appendicitis? Or are the findings considered negative if the appendix is simply not visualized?

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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
GREAT.

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.

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. 
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. 

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.

 

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

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