Appendix US (last edited 10/19/2017)
(last reviewed 10/19/2017)
(last reviewed 10/19/2017)
- Transverse images of the right lower quadrant and at the area of the patient’s pain
- Sagittal images of the right lower quadrant and at the area of the patient’s pain
- Compression of the right lower quadrant and at the area of the patient’s pain (utilize split screen labeling image w/ and w/out compression.
- Color, power and duplex doppler interrogation as needed.
Appendix/RLQ:
Sagittal and tranverse views of the right lower quadrant and the area where the patient has pain. Label orientation and location. Perform with linear and curvilinear probes. Compression ultrasound with a linear probe.
Notes:
Ask patient to point to the area of pain with one finger. This can help in finding the appendix. Make sure to examine this area even it is not in the right lower quadrant. Make sure to also examine the right lower quadrant.
Perform compression ultrasound with -resolution ( ≥ 7.5 MHz) linear array transducer at the right lower quadrant and at the area of the patient’s pain. When performing the graded compression, the common femoral artery and vein is identified in order to orient to the RLQ. The patient is then scanned cephalad from this position. The transducer is then used to compress the RLQ, including the terminal ileum and the cecum, to identify any possible appendix. Better compression is obtained if the left hand is placed behind the patient's flank.
An abnormal appendix appears as a dilated (> 6mm), tubular, non-compressible, non-peristaltic, blind-ending structure originating from the cecum. The signs for appendicitis include :
Thickened wall > 3mm
Diameter > than 6mm
Blind-ending tubular structure
Non-compressible
Appendicolith
Circumferential color flow
Free fluid
Abscess
The lack of visualization of an abnormal appendix does NOT exclude appendicitis.
Normal bowel can mimic an abnormal appendix. Normal bowel peristalses with time and should be compressible.
If the patient is painful over the ovary
Females: Complete female pelvic sonography (if pelvic US ordered by MD)
Perform pelvic sonography in females as per female pelvic sonography protocol and include RLQ.
Charge pelvic ultrasound
Males: RLQ sonography
Perform RLQ protocol as per the Appendix sonography above.
Charge abdomen limited