25/12/2025
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๐นIntroduction
Acute appendicitis is the most common surgical cause of right iliac fossa pain. Ultrasound is usually the first imaging choice, especially in young and thin patients, because itโs quick, safe, and gives real-time correlation with pain.
๐นUltrasound Technique
Graded compression is key.
Use a high-frequency linear probe and scan at the point of maximum tenderness. Apply slow, steady pressure to displace bowel gas. Identify the cecum and trace it to find a blind-ending tubular structure. Always scan in both longitudinal and transverse planes.
๐น Ultrasound Findings
The inflamed appendix appears as a non-compressible blind-ending tube with an outer diameter greater than 6 mm. Wall thickening and a target appearance on transverse view are typical. Echogenic surrounding fat, free fluid, or an appendicolith further support the diagnosis.
๐นDoppler Findings
In early appendicitis, increased vascularity is seen in the appendiceal wall. In advanced or gangrenous cases, Doppler flow may be reduced or absent due to ischemia.
๐น Laboratory Correlation
Raised white blood cell count with neutrophilia supports infection. Elevated CRP indicates inflammation and helps assess severity. Normal labs with a normal ultrasound make appendicitis less likely, but early cases can still have mild lab changes.
๐น Surgical Opinion
Clear sonographic evidence of appendicitis with supportive labs usually leads directly to surgery, especially in children. Findings such as appendicolith, free fluid, or loss of wall layers raise concern for complications and increase surgical urgency. Equivocal cases require close clinical correlation or further imaging.
