COTW September 13th: A 75 y/o F with RLQ pain for about a week
The patient comes in with marked RLQ tenderness, nausea, GI upset, steadily getting worse… so you put a probe on…
Notice that mucosal structure with some surrounding fluid… so you keep scanning…
That’s A LOT of fluid! What is it? Could it be an Appy?
First, let’s review acute appendicitis ultrasound:
Start on the point of maximal tenderness using the linear transducer and scan through the entire RLQ.
Search for the aperistaltic, non-compressible, blind ended structure.
Measure at the greatest diameter, > 6mm suggests appy
Surrounding fluid collection gives it the classic, target appearance on axial section
So… did our patient have appendicitis? Why was it different?
Diagnosis: Perforated, acute appendicitis with an abscess
Key differences between perforated and non-perforated appy:
Larger fluid collection that is not just closely surrounding the appy
Mucosal surfaces may appear closer to each other, or even come in contact, as the inner fluid has leaked out
Irregular appearance, not showing classic target shape on axial view