This is a 6 year old female presenting to the ED with 1 day of severe abdominal pain and nausea/vomiting. The patient reported her pain was initially umbilical but moved to RLQ. When we went to ultrasound this patient, she had already received pain medication and the diagnosis of appendicitis was known through CT. Usually when ultrasounding for appendicitis, it is useful to have the patient point to their pain and to start from there with a linear probe. In this case however, this patient did not have pain. We started looking for the psoas muscle and iliac vessels. Once those are found the goal is to compress the bowel and look for any non-compressible structure. Once that is found, it would be a blind-loop and look for a target sign. We were able to see exactly this in this patient relatively easily.
Ultrasound for appendicitis in the pediatric population is vital. It prevents a large amount of ionizing radiation. However, it is often difficult to find the appendix, especially in the adult population or obese patients.
Findings that support appendicitis include:
• Noncompressible appendix with a diameter >6 mm, better if wall layers are seen
• fat surrounding the appendix
• fluid collection surrounding the appendix
• target like appearance
Of course it is always necessary to make sure the structure has a blind ending and is arising from the cecum. In this case, the ultrasound would be sufficient to make the diagnosis of appendicitis with the clinical picture and a CT may not have needed to be done.
-Talar Kavafyan, MS4