simple inflamed appendicitis has limitation in diagnosis using simple and cheap ultrasound machines. Any other way from new modern ultrasounds apart from clinical assessment and costly CT and MRI..
appendicitis has so far been diagnosed clinically with obvious few negative appendectomy. Alvarado's scoring system is helpful. If the score is < 6 or the clinical diagnosis is equivocal or not forthcoming in favor of appendicitis we should not miss other condition. Hence the role of USG - cheap, fast and mostly accurate without radiation hazard and can be done on the bedsie.
High frequency B-mode ultrasound can be used to diagnose vermiform appendicitis but there are factors that could limit its effectiveness such as if the appendix is retrocaecal. Also in very acute appendicitis when the sonographic signs may still be subtle, the sonography may be negative except for probe tenderness over the right iliac fossa. For this reasons, B-mode ultrasound is used to check for complications of appendicitis such as pelvic abscess in most cases.
To have a definitive diagnosis of appendicitis using ultrasound, B-mode ultrasound would have to be combined with colour Doppler ultrasound imaging (CDI). Hyperaemia around the vermiform appendix at CDI is one of the classical signs of appendicitis.
I hope this helps.
Thank you.
Ultrasound has a definite role in diagnosing appendicitis. It is easily accessible and cost effective. It can rule out other causes of RIF pain .Ct is most sensitive. A blind ending tubular aperistaltic non compressible structure of calibre>= 6 mm with associated fluid collection, omental thickening, caecal thickening, lymph nodes are suggestive of appendicitis. In operator's expertise is needed.
Ultrasound is very useful in the diagnosis of acute appendicitis, particularly in children where the burden of radiation exposure from CT scans are more of an issue than in adults. Consider the use of both high frequency linear trandsducers, and also mid-low frequency curvi-linear transducers. Ultrasound has a high negative predictive value, even when the appendix is not directly seen with ultrasound, and there is a lack of secondary signs that are mentioned above.
Thank you.
Article Ultrasound of paediatric appendicitis and its secondary sono...
If you are not experienced and don't involve in this pathology on everyday basis, ultrasound is of no use to you and your patients, in the most cases. Clinical examination and surgeon assesement should still be the number one diagnostic tool.
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