Acute appendicitis is a very common condition that can be the main reason for abdominal surgery in young inflammation of the appendix. Early detection can help you prevent severe complications. Ultrasound is the best way to detect appendicitis. Learn how ultrasound is used to detect appendicitis and pitfalls in this article. You can contact us by visiting our clinic or visiting our website at https://doralhw.org/.

Role of ultrasound in appendicitis diagnosis

Ultrasound allows the investigation of appendicitis in young patients especially, women of childbearing age as it doesn’t need ionizing radiation. It is very reliable at identifying abnormal appendices, especially in thin patients. However, sometimes, ultrasound misses the normal appendix, and, in many instances, it is not able to rule out appendicitis.

The most common ultrasound technique used for appendicitis diagnosis is known as graded compression. In this technique, the doctor uses a linear probe over the site to make maximal tenderness and gradually increase the pressure toward normal overlying bowel gas. Changes in position may allow for an increase in the visualization rate.

Finding support for appendicitis diagnosis includes:

• A peristaltic, non-compressible, fluid-filled blind-ending tube.
• >6 mmouter diameter is used (ultrasound measurements are slightly 1 to 2 mm smaller than CT scan measurements).
• Hyperechoic appendicolith with posterior acoustic shadowing.
• Identification of wall layers
  • Normal 5 layers of non-necrotic (catarrhal appendicitis)
  • Loss of wall stratification indicates necrosis.
  • Gas locules in appendicitis indicate gangrene
• Peri appendiceal hyperechoic indurated fat (>10 mm) surrounding a non-compressible appendix with a diameter >6 mm.
• Peri appendiceal complex fluid collection
• Peri appendiceal reactive lymphadenopathy
• Wall thickening (3mmor above)
  • Mural or extramural hyperemia with color flow Doppler can increase the specificity.
  • Vascular flow may not be present in a necrotic segment.
• Alteration of the mural spectral Doppler envelope
  • May support diagnosis in equivocal cases.
  • A peak systolic velocity >10 cm/s indicates a cutoff.
  • A resistive index (RI) is measured at >0.65, however, it can be more specific.

Confirming that the structure visualized in the appendix is important and needs a demonstration of the blind-ending and arising from the base of the cecum. Identifying the terminal ileum is immensely helpful.

A dynamic ultrasound technique can use a sequential 3-step patient positioning protocol to increase the detection rate of Appendix. In the study, patients start to be examined in the conventional supine position which is followed by the left posterior oblique position (45° LPO), and then a second-look spine position. Reports show that detection rates increased from 30% when you start the supine position, to 44% in the LPO position and further increased to 53% with the second-look supine position. Slightly larger absolute and relative detection rates are found in children. The effect of the LPO positioning gets better with the acoustic window by shifting bowel contents to the left, away from the appendix.

If you need help with your abdominal problems, visit our gastroenterology clinic in Brooklyn to get professional medical help. You can schedule an appointment with Doral Health and Wellness Gastroenterology Center’s best gastro doctors in Brooklyn. If you are looking for treatments, you can also talk to our specialists and inquire with them. To schedule an appointment, please visit us at 1797 Pitkin Avenue, Brooklyn, New York 11212 or call 1-347-384-5690. 

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