Acute Appendicitis

This 12 year-old girl presented with right iliac fossa pain. An abdominal ultrasound shows a blind-ending tubular structure with a diameter of 10mm in the right iliac fossa, surrounded by hyperechoic fat. The findings are diagnostic of acute appendicitis (although the differential diagnosis of Meckel’s diverticulitis should not be forgotten).
Ultrasound is the imaging test of choice for the diagnosis of acute appendicitis in children, as there is no radiation exposure, and they are usually thinner than adults. An exception is the overweight or obese child, where ultrasound visualisation is poor. In this case, CT may be more useful. As ultrasound has a lower reported sensitivity than CT, CT may be helpful in the setting of ongoing pain when the ultrasound is negative. One reason for a negative ultrasound is the retrocaecal appendix.
Reference: Devadass A. CT vs USS in the diagnosis of acute appendicitis. BestBETS.org
Credit: Dr Laughlin Dawes
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