Surgical Images
Imagier chirurgical

Ultrasound diagnosis of acute appendicitis

Section Editors: David P. Girvan, MD, and Nis Schmidt, MD

Canadian Journal of Surgery 1997;40(4):251-52.

Submitted by Emma.J. Patterson, MD, and A.R. Jean Buckley, MB, Department of Surgery, Vancouver Hospital and Health Sciences Centre, Vancouver, BC

Submissions to Surgical Images should be sent to Dr. David P. Girvan, Victoria Hospital Corporation, PO Box 5375, Station B, London ON N6A 5A5 or to Dr. Nis Schmidt, Department of Surgery, St. Paul's Hospital, 1081 Burrard St., Vancouver BC V6Z 1Y6, with a copy of the submitting letter to Dr. Jonathan L. Meakins, Rm. S10.34, Royal Victoria Hospital, 687 Pine Ave. W, Montreal QC H3A 1A1

© 1997 Canadian Medical Association

An 83-year-old woman presented with a 2-day history of sharp right flank and right lower quadrant (RLQ) pain. Previously, she had been healthy and she denied any urinary symptoms or change in bowel habit. She was afebrile and her vital signs were normal; she had RLQ tenderness but no peritoneal signs. Plain radiographs (3 views of the abdomen) were nonspecific. High-resolution, real-time ultrasonography (US) with graded compression was used to assess the patient for possible appendicitis (Fig. 1, Fig. 2, Fig. 3 and Fig. 4).

US revealed a blind-ended segment of bowel in the RLQ that was noncompressible and without peristalsis (Fig. 1), consistent with an inflamed appendix. In the transverse plane, the appendix is seen as a target lesion (Fig. 2). The diameter of the appendix was 8.8 mm in the anterior­posterior dimension (Figs. 1 and 2). An appendicolith (white arrows) with acoustic shadowing was demonstrated in the base of the appendix in both longitudinal and transverse planes (Figs. 3 and 4). The patient underwent appendectomy that evening and gangrenous acute appendicitis was confirmed pathologically.

The technique of graded compression US for the diagnosis of acute appendicitis was first described by Puylaert1 in 1986. Using the ultrasonographic criterion of visualization of a noncompressible appendix, Jeffrey, Laing and Lewis2 found that the sensitivity of US in the diagnosis of acute appendicitis was 89%, with a specificity of 95%. In the 90 patients they assessed with suspected acute appendicitis, the positive predictive value was 89% and the negative predictive value was 95%.

High-resolution real-time US with a graded compression technique may reduce the number of normal appendices removed, particularly in ovulating females, in whom up to 40% of appendectomy specimens show no pathognomic evidence of inflammation.3

References

  1. Puylaert JBCM. Acute appendicitis: US evaluation using graded compression. Radiology 1986;158:355-60.
  2. Jeffrey RB, Laing FC, Lewis RF. Acute appendicitis: high-resolution real-time US findings. Radiology 1987;163:11-4.
  3. Dunn EL, Moore EE, Eldering SC, Murphy JR. The unnecessary laparotomy for appendicitis: Can it be decreased? Am Surg 1982;48:320-3.
| CJS: August 1997 / JCC : août 1997 |
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