RadteraUltrasound Appendix (RLQ, Pediatric Appendicitis)
USNo contrastPediatric
Indications
- Suspected acute appendicitis
- RLQ pain in children/young adults
- Avoidance of ionizing radiation as first-line imaging
Patient prep
- None typically; comfortable supine position
- Point of maximal tenderness used to guide scanning
Contrast
None / non-contrast
Technique
- High-frequency linear transducer 7-15 MHz (curvilinear for larger/deeper patients)
- Graded compression technique over RLQ / point of maximal tenderness
- Identify appendix as blind-ending, non-peristaltic tubular structure arising from cecal base
- Color Doppler for wall hyperemia
Series / Sequences
| # | Series / Sequence | Plane | Notes |
|---|---|---|---|
| 1 | Appendix long axis | Long axis | Blind-ending, non-compressible; measure length |
| 2 | Appendix transverse - maximal outer diameter | Transverse | Outer wall-to-outer wall diameter; >6 mm abnormal (6-8 mm equivocal) |
| 3 | Appendiceal wall | As needed | Wall thickness >3 mm; hyperemia on color Doppler |
| 4 | Periappendiceal region | As needed | Free fluid, fat stranding/echogenic fat, abscess, appendicolith |
Key points
- Diagnostic: non-compressible blind-ending tubular structure with outer diameter >6 mm (6-8 mm equivocal, >8 mm more definitive)
- Supportive findings: wall thickening >3 mm, hyperemia, appendicolith, periappendiceal fluid/echogenic fat
- Graded compression to displace bowel gas is the core technique
- Non-visualization does not exclude appendicitis; correlate clinically or proceed to MRI/CT per protocol
References
• AIUM/ACR Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen (pediatric appendix)
• ACR Appropriateness Criteria: Right Lower Quadrant Pain — Suspected Appendicitis
• Radiopaedia: Appendicitis (ultrasound) link
• ACR Appropriateness Criteria: Right Lower Quadrant Pain — Suspected Appendicitis
• Radiopaedia: Appendicitis (ultrasound) link
Source: Researched — verify against your institution
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Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.