First AD

Second AD

A 9-year-old male presents with acute onset abdominal pain with fever, vomiting, and diarrhea.  His abdomen on exam was mildly distended and diffusely tender to palpation, especially in the right upper quadrant and right lower quadrant.

Ultrasound demonstrates a blind ending tubular structure in the right lower quadrant measuring approximately 1 cm in luminal diameter.


Ultrasound images demonstrate a thick-walled, distended appendix with significant hyperemia.  A 1.5-cm appendicolith is seen at the proximal end of the appendix. There is surrounding fat stranding, as well as a small amount of free fluid.


Ultrasound is often the first line imaging modality in children presenting with acute abdominal pain because of its lack of ionizing radiation. Sonographic findings of acute appendicitis include visualization of a blind-ending tubular structure greater than 6 mm in outer diameter, corresponding to a dilated appendix, non-compressibility of the appendix, and hyperemia of the appendiceal wall. Occasionally, a highly echogenic appendicolith may be visualized as well.  Secondary signs include hyperemia on color Doppler and inflammatory change of the surrounding mesenteric fat, as well as bowel wall thickening of adjacent small bowel loops and cecum.


Lee JH. Sonography of acute appendicitis. 

Ultrasound

9-year-old male presents with acute onset abdominal pain with fever, vomiting, and diarrhea.

Image IQ: 9-year-old Male with Abdominal Pain

Geraldine Liao, MD