Acute appendicitis I

First published on SonoWorld

Case Presentation
A 26 year old man presents with acute onset pain in the right iliac fossa. An ultrasound was performed

Transverse image of the right iliac fossa
Caption: Transverse image of the right iliac fossa | Description: There is a fluid-filled, distended, non-compressible tubular structure seen in the right iliac fossa. The walls of this tubular structure appear thickened. This area was tender with transducer pressure. The surrounding mesenteric fat appears highly echogenic.
Transverse color Doppler image
Caption: Transverse color Doppler image | Description: A part of the wall of the tubular structure shows increased vascularity, suggestive of an inflammatory process.
Power Doppler image
Caption: Power Doppler image | Description: This image also demonstrates the increased vascularity seen in parts of the wall. Other areas of the wall show no flow at all.
3D appearance of the appendix
Caption: 3D appearance of the appendix | Description: The 3D rendering depicts good surface morphology. Some parts of the wall of the appendix shows necrosis, which corresponds to areas of avascularity seen on the color and power Doppler scans.

Differential Diagnosis

Acute appendicitis

Final Diagnosis

Acute appendicitis


Hyperemia, when demonstrated in the wall of the appendix, is a sensitive indicator of inflammation and the case demonstrated here illustrates this feature. It also shows all the other classical features of acute appendicitis.

1. Lim HK, Lee WJ, Kim TH, Namgung S, Lee SJ, Lim JH. Appendicitis: usefulness of color Doppler US. Radiology. 1996 Oct;201(1):221-5.
2. Quillin SP, Siegel MJ. Appendicitis: efficacy of color Doppler sonography. Radiology. 1994 May;191(2):557-60.