Sonographic diagnosis of appendicitis: A pictorial essay and a new diagnostic maneuver

Abstract

While many cases of appendicitis are easy to diagnose clinically, a significant number need further workup in the form of imaging. Ultrasound and CT are both used extensively to diagnose or exclude appendicitis, or arrive at an alternate diagnosis. Ultrasound has many advantages but can be a difficult modality to use due to, among other reasons, the anatomical variations in appendicial location. The true retrocolic appendix is particularly difficult to diagnose with ultrasound. This pictorial essay examines the ultrasound features of normal and diseased appendix and proposes a new examining station, the prone view, for visualizing true retrocolic appendicitis.

Editorial: routine use of intestinal ultrasound in ulcerative colitis—are we missing the appendix? Authors' reply

“…The presence of appendiceal inflammation is assumed if the transverse appendiceal diameter (TAD) exceeds 6 mm, according to the cut-off for acute appendicitis on ultrasound. 9 Therefore, we are currently conducting an extension of the current study, in which UC patients underwent colonoscopy, appendiceal IUS and consecutive appendicectomy. The correlation between endoscopic PARP, appendiceal IUS findings and histopathologic appendiceal inflammation will be explored.…”

“…Next to agreement, correlation to a gold standard is mandatory. The presence of appendiceal inflammation is assumed if the transverse appendiceal diameter (TAD) exceeds 6 mm, according to the cut‐off for acute appendicitis on ultrasound 9 . Therefore, we are currently conducting an extension of the current study, in which UC patients underwent colonoscopy, appendiceal IUS and consecutive appendicectomy.…”

Intestinal ultrasound detects an increased diameter and submucosal layer thickness in the appendix of patients with ulcerative colitis compared to healthy controls – a prospective cohort study

“…[9][10][11] Intestinal ultrasound (IUS) is a non-invasive and easily accessible cross-sectional imaging modality with an appendiceal detection rate that ranges between 49 and 82%. [16][17][18][19] IUS is widely established in diagnosing acute appendicitis with a 75%-85% accuracy. One of the leading IUS parameters supporting the diagnosis of acute appendicitis in presence of a clinical suspicion is a transverse appendiceal diameter (TAD) exceeding 6 millimetres (mm).…”

“…One of the leading IUS parameters supporting the diagnosis of acute appendicitis in presence of a clinical suspicion is a transverse appendiceal diameter (TAD) exceeding 6 millimetres (mm). 17 , 20 , 21 , 22 IUS is emerging as imaging modality in UC as it is accurate in determining disease activity and monitoring treatment response. 23 , 24 , 25 Appendiceal inflammation on IUS in UC patients has not been described previously.…”

Apendicitis Aguda

“…La inflamación del apéndice cecal origina la patología, como consecuencia del taponamiento u obstrucción de la luz apendicular, generando congestión venosa, posterior al compromiso arterial en la pared apendicular y por ende la perforación de este (1). Una de las principales causas de abdomen agudo en pacientes quirúrgicos es la apendicitis aguda, presentándose usualmente en pacientes jóvenes (11-20 años), sin embargo, ninguna edad es inmune a esta patología y se puede observar en todos los grupos etarios (2) . Se estima una incidencia de 100 a 151 por 100.000 personas en América del Norte, Europa del Este y Europa Occidental y una tasa de mortalidad alrededor de 0,25%, siendo el sexo femenino el más frecuente, pero con una tasa de mortalidad mayor a comparación del sexo masculino (3).…”