Pediatric emergency medicine trisk 4510 4510
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medially will provide a focused area of investigation for the appendiceal body. A
noninflammed appendix will have intact gut wall signature with intact peristalsis.
An acute appendicitis will have notable increase in size measuring 6 mm or
greater, be noncompressible, and will often have surrounding periappendiceal fat
stranding (Fig. 131.21 and
Video 131.20 ).
FIGURE 131.21 Appendicitis. Note the enlarged appendix (arrow ) adjacent to the iliac vessels
(IV) and near the psoas muscle (PM) viewed in cross section.
Pitfalls
Obesity often prevents visualization of the appendiceal body on ultrasound. In a
patient with significant abdominal pain the ultrasound examination can cause pain
that limits the ability to perform graded compression. This can be mitigated with
narcotic analgesia but in a patient with peritonitis, there may still be difficulty in
obtaining adequate images. Retrocecal appendiceal bodies often require a lateral
approach and it may not be feasible to identify with the limited depth of a highfrequency linear probe. Finally, the sonographer should be aware of the variable
sensitivity of ultrasound in bedside assessment of appendicitis. Thus
nonvisualization of the appendix should be considered nondiagnostic rather than a
negative study.
PROCEDURAL APPLICATIONS
