Discussion:
Acute appendicitis is one of the most common causes of acute abdominal pain in children. The pathophysiology typically involves luminal obstruction, most commonly due to lymphoid hyperplasia in children, leading to increased intraluminal pressure, ischemia, and subsequent inflammation of the appendix. If untreated, this can progress to gangrene, perforation, and generalized peritonitis. Ultrasound is often performed as the first-line imaging in patients where there is a suspicion of appendicitis, particularly in children, due to its non-invasive nature and lack of ionizing radiation. Classic ultrasound findings include a non-compressible, blind-ending tubular structure in the RLQ with a diameter exceeding 6 mm. Additional findings, such as periappendicular fluid, increased echogenicity of the surrounding fat, or the presence of an appendicolith, can further support the diagnosis. In our case the lack of widespread fluid or systemic symptoms ruled out diffuse inflammatory processes, helping to guide prompt management.
Radiologists must differentiate appendicitis from other conditions such as mesenteric adenitis or ovarian torsion, which can present similarly. Careful interpretation of ultrasound findings, combined with clinical history, ensures accurate diagnosis and timely management, particularly when complications like abscess or perforation are suspected.
This case underlines the importance of a systematic ultrasound evaluation in the right lower quadrant, understanding key anatomical landmarks, and recognizing the sonographic signs of appendicitis. Radiologists must also know when further imaging, such as CT or MRI, is needed in ambiguous cases, particularly when non-operative management is considered.
Question 3: When performing an ultrasound examination for suspected appendicitis in a pediatric patient, what is the most important factor in choosing the appropriate transducer?
