Scan the right lower quadrant at low depth and high resolution. A normal appendix is hard to see even for experts. Appendicitis is defined as enlarged (greater than 0.8cm), tubular, non-compressible, blind-ended structure. Secondary signs can be hyperechoic surrounding fat, increased surrounding color doppler signal, local ileus of surrounding intestines, or free fluid.
in a patient presenting with abdominal pain signs of appendicitis can be seen quickly at the bedside and expedite treatment pathways and then with a high enough quality image and a bit of good luck identifying a normal appendix can effectively rule out the disease to do this scan you need a high quality curvilinear transducer here i am on superficial preset and i'm going to take the indicator towards the patient right side and i'm going to start at the level of the patient's umbilicus in a transverse orientation with the indicator to the patient's right i'm going to apply some gentle pressure and i'm going to slide that transducer off to the patient's right until i find the so-called dirty shadowing of the colon above and superficial i can see the abdominal wall musculature i'm going to slide the transducer down towards the patient's feet until that dirty shadowing ends signifying i've reached the level of the cecum once i'm there i can go back up into the abdomen and with a bit of luck and exploration i'm going to try and identify the structure most consistent with the appendix it can be tricky to find attached to the cecum but once you've identified a small blind ended structure here measuring only a couple millimeters in thickness you can see why getting such a high quality image is so important to really effectively identify a normal healthy appendix but once i have identified the appendix i can feel confident that i've essentially ruled out the disease
