31 May

The role of radiological imaging in the diagnosis of acute appendicitis: ULTRASONOGRAPHY Part 1

ULTRASONOGRAPHYThe usefulness of ultrasonography in the diagnosis of appendicitis has been known since the early 1980s. It is safe (including during pregnancy) and relatively inexpensive, and can be performed quickly and repeatedly, using portable equipment. The patient can indicate the point of maximal tenderness, to which the transducer can be applied. This can facilitate the diagnosis when the appendix is in an atypical location. Children, because of the relative paucity of intra-abdominal fat, and young women, who are susceptible to gynecological disorders, are especially good candidates for sonography.
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Sonography has, however, several limitations. Some of the limitations are nonspecific: obesity, intestinal gas, patient cooperation, quality of equipment, and the skill and experience of the technician. Other limitations are particularly relevant to acute appendicitis (Table 3).

TABLE 3
Limitations of sonography in the diagnosis of acute appendicitis

Dilation of loops of bowel in the right lower quadrant can obscure the inflamed appendix
The inflamed appendix can be difficult to distinguish from the terminal ileum
The patient may not tolerate application of the transducer to the painful area
The transducer may not have enough spatial resolution to visualize such a small structure as the early inflamed appendix

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