A 27-year-old male with no significant PMH presented to the ED with complaints of RLQ abdominal pain that had been ongoing for 11 hours. He also reported nausea, vomiting, diarrhea, anorexia, and fever.
Initial VS: BP 109/58, HR 94, T 38.5 °C (101.3 °F), RR 12, SpO2 97% on RA
Physical exam revealed tenderness to palpation in the RLQ without rebound. He did have voluntary guarding.
The physicians taking care of the patient decided to do a bedside ultrasound to look for appendicitis.
To do this exam, have the patient point to the area in their abdomen that hurts the most. Then, place the transducer over that area and apply pressure with graded compression. You will be looking for a blind-ended tubular structure. A linear transducer or high-frequency curvilinear transducer usually works best for this exam.
This is what the clinicians saw when they placed the transducer in the RLQ:
This is a longitudinal view of the appendix, but what are the diagnostic criteria for appendicitis?
Three criteria need to be met to diagnose appendicitis with ultrasound. There has to be a (1) blind-ended tubular structure that is (2) non-compressible and (3) measures more than 6 mm in diameter.
Here is a transverse view of the appendix:
In this image you can see that the appendix is non-compressible.
Here is the measurement of the thickness:
You can see that it measures >6mm.
After obtaining these images, the ED team consulted surgery. The surgical team agreed to take the patient to the OR without further imaging.
Would your surgeon take this patient to the OR based off of the ED performed ultrasound? What if the patient were a female?
