Introduction
Appendicitis: aetiology and demographics
Clinical diagnosis of appendicitis
Clinical signs and symptoms
Laboratory markers
Scores
When to use imaging
Ultrasound
Real-time compression ultrasound
Alvarado score (MANTRELS) | Paediatric appendicitis score (Samuel score) | ||
---|---|---|---|
Diagnostic criteria | Value | Diagnostic criteria | Value |
Migration pain to RLQ | 1 | Migration pain to RLQ | 1 |
Anorexia/acetone in urine | 1 | Anorexia | 1 |
Nausea–vomiting | 1 | Nausea/emesis | 1 |
Tenderness in RLQ | 2 | Tenderness in RLQ | 2 |
Rebound pain | 1 | Cough/percussion tenderness | 2 |
Temperature ≥ 37.3 °C | 1 | Pyrexia (not defined) | 1 |
Leucocytosis (>10 x 103/L | 2 | Leucocytosis (> 10x103/L) | 1 |
Leucocyte shift to left (>75 %) | 1 | Neutrophilia | 1 |
Total score | 10 | Total score | 10 |
Real-time US signs of acute appendicitis | |
---|---|
Direct signs | Indirect signs |
Non-compressibility of the appendix Perforation: appendix might be compressible | Free fluid surrounding appendix |
Diameter of the appendix > 6 mm | Local abscess formation |
Single wall thickness ≥ 3 mm | Increased echogenicity of local mesenteric fat |
Target sign: Hypoechoic fluid-filled lumen Hyperechoic mucosa/submucosa Hypoechoic muscularis layer | Enlarged local mesenteric lymph nodes |
Appendicolith: hyperechoic with posterior shadowing | Thickening of the peritoneum |
Colour Doppler and contrast-enhanced US: Hypervascularity in early stages of AA Hypo- to avascularity in abscess and necrosis | Signs of secondary small bowel obstruction |