Diagnosis of appendicitis with ultrasound: case example

Abstract

A 52-year-old man presented with a complaint of crampy abdominal pain for the prior 2 days. He described the pain as diffusely located throughout the abdomen but slightly worse in the right lower quadrant. He denied nausea, vomiting, chills, dysuria, frequency, urgency, or fever, but he noted constipation, with no bowel movement for the prior 4 days. He had no prior surgeries and the past medical history was significant only for mild depression, for which the patient was treated with Effexor. Vital signs on the initial examination included a blood pressure of 123/61 torr, heart rate of 83 beats/min, respiratory rate of 18 breaths/min, and temperature of 36.5°C. The abdomen was nondistended with normal bowel sounds and mild tenderness in the right lower quadrant. There were no peritoneal signs and no hernias. Rovsing’s sign was absent. The rectal examination showed normal sphincter tone without marked tenderness and the stool was hemoccult negative. The remainder of the physical examination was unremarkable. A bedside ultrasound (US) examination was performed by the Emergency Physician using a 7.5-MHz linear array transducer. It revealed a noncompressible appendix with a classic target shape or “bull’s-eye” appearance with a circular configuration and a diameter of 1.2 cm (Figures 1 and 2). No peristaltic activity was visible. The CBC revealed a white count of 12.2 with 84% neutrophils. A surgical consult was obtained and the patient was taken to the operating room where a laparoscopic appendectomy was performed, revealing acute appendicitis.