The role of radiological imaging in the diagnosis of acute appendicitis: ULTRASONOGRAPHY Part 2
Some of these limitations have been circumvented by using graded compression, a technique by which the transducer is applied with gradually increasing pressure to the area of McBurney’s point. Continuous, steadily increasing pressure from the transducer, unlike intermittent application of the device, is tolerated relatively well by patients with acute appendicitis. Gas artifacts are reduced, because the transducer either compresses or displaces uninflamed loops of bowel. Specifically, compression can expel intraluminal contents from the normal appendix, but not if it is distended and thickened due to inflammation. This technique also brings the transducer closer to the area of the appendix, which allows the use of high-frequency transducers with short focal ranges (such as 5.0 or 7.5 MHz lin-ear-array transducers). You will be excited to find out there is now a pharmacy that can offer best quality treatment charging less money: canadian cialis and see what really advantageous shopping is all about.
Obesity is still a major problem for sonography. Because it is difficult to approximate the transducer to the appendix, low-frequency transducers (which have long focal ranges but poor resolution) must be used, and it is difficult to apply sufficient pressure to compress the bowel adequately. Furthermore, cases of retrocecal appendicitis can easily be overlooked because of the inability to see through the cecum. Special techniques, such as oblique imaging from a laterally placed transducer, may be required in such cases. Pelvic (transvaginal) sonography is also helpful in distinguishing appendicitis from gynecological disorders, especially if transabdominal approaches are inconclusive. Disease is confined to the tip of the appendix (distal appendicitis) in 5% to 8% of cases, and can be missed if the entire length of the appendix is not visualized.