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Global Renal Ischemia
Joseph Junewick, MD FACR
over 5 years ago
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Case History

10 year old male with right lower quadrant pain.

Case Detail

Anatomy: Gastrointestinal
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
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Reveal Clinical Notes

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

Reveal Findings

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

Reveal 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.

Reveal Diagnosis

Tip Appendicitis

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