This 30 year old man had developed diffuse abdominal pain which was localised to his right iliac fossa by the following morning. He felt well and was afebile with normal pulse and blood pressure. On examination of the abdomen, there was tenderness in the RIF on deep palpation.Urinalysis was normal Further investigation revealed a normal WCC and (mildly) elevated CRP at 26.
Tranverse diameter of blind ending loop with a diameter > 6mm
On the basis of the ultrasound findings, the patient was taken to theatre. A suppurative appendix was removed. Sonographic features of appendicitis include a blind ended tubular structure with a 'gut signature', preferably traced to the base of the caecum which is non compressible, aperistaltic and with a diameter greater than 6mm. Additional features which lend support to the sonographic diagnosis include inflamed perimesenteric fat, adjacent fluid and an appendicolith.
Additional useful articles
Monneuse O, Abdalla S, Pilleul F, Hervieu V, Gruner L, Tissot E, Barth X. Pain as the only consistent sign of acute appendicitis:lack of inflammatory signs does not exclude the diagnosis. World J Surg 2010 Feb 34 (2):210-5
Ackerman S, Irshad A, Anis M. Ultrasound for Pelvic Pain II: Non gynaecologic causes Ultrasound Clin 5 (2010) 233-243