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Joseph Junewick, MD FACR
over 7 years ago
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Tip Appendicitis

Case Detail

Anatomy: Gastrointestinal
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Infectious-Inflammatory
Created: over 6 years ago
Updated: over 6 years ago
Tags: PEDS
Modality/Study Types: US CT
Activities:
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History

10 year old male with right lower quadrant pain.


Case Images


Diagnosis

Tip Appendicitis

Clinical Notes

Pathology revealed mural inflammation of the tip of the appendix and enterobius vermiformis (pinworms) in proximal appendix.

Findings

US – Distal appendix dilated by fluid; hyperechoic non-shadowing material in proximal appendix.

Discussion

US is useful in the evaluation of appendicitis. A diameter > 6 mm with compression has a high positive predictive value for appendicitis. Other helpful signs of appendicitis include 1) Loss of the echogenic mucosal stripe reflects ischemic ulceration, 2) Loculated periappendiceal fluid is virtually diagnostic of perforated appendicitis, 3) Mural hyperemia on color Doppler indicates inflammation; mural pneumatosis and lack of color Doppler flow are seen with gangrenous appendicitis, 4) Increased periappendiceal and pericecal echogenicity is related to mesenteric and/or omental inflammation, 5) Periappendiceal fluid, mesenteric adenopathy and adynamic small bowel are less specific ultrasound findings. Appendicoliths in symptomatic patients are associated with higher rate of perforation. To exclude appendicitis, the entire length of the appendix should be evaluated in order to avoid a false-negative diagnosis.

Reference

Kessler N, Cyteval C, Gallix B et al. Appendicitis: Evaluation of Sensitivity, Specificity, and Predictive Values of US, Doppler US, and Laboratory Findings. Radiology (2004); 230:472-478

Lim HK, Lee Wj, Lee SJ et al. Focal appendicitis confined to the tip: diagnosis at US. Radiology (1996); 200:799-801



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