Monday, July 3, 2017

Ultrasonography in Acute Appendicitis

Hey Awesomites

Ultrasonography ( graded compression technique ) is the investigation of choice in cases of acute appendicitis.

A linear probe is passed over the area of maximal thickness and pressure is applied gradually to displace the overlying gas, if any, to clear the view.

If the appendix is normal ( intraluminal diameter less than 6mm with no signs of obstruction ), it is compressible and shows peristaltic movements.
But if it is inflamed, the appendix shows no signs of peristalsis and is incompressible and dilated ( >6mm diameter ).

Also, peri - appendiceal hyperechoic structure ( diameter usually >10mm ) is seen surrounding the incompressible appendix, with variable amounts of fluid collection.

Note - To confirm that the structure visualised is appendix, the patient's position is changed from supine to left posterior oblique position ( at 45° angle ) and then again at "second - look" supine position.

However, if position of appendix is behind the caecum ( ascending/ transverse retrocaecal ), it is difficult to visualize the structure. In such cases, CT scan helps in early management and lower rates of unnecessary appendecectomies in female patients.

Thats all
- Jaskunwar Singh

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