Translations:Appendicitis/92/en

• Early surgical consultation should be obtained before imaging in straightforward cases
• Not universally necessary; consider in:
  • Women of reproductive age
  • Men with equivocal presentation
• Perforation may result in false negative study
• Imaging modalities
  • Ultrasound
    • First choice for pregnant women and children
    • Limitations: operator-dependent, difficult to visualize with obesity, gravid uterus, bowel gas, guarding, lack of patient cooperation
    • Findings: noncompressible appendix >6mm in diameter, wall thickness greater or equal to 3 mm
    • Other supportive findings: aperistalsis, distinct wall layers, target appearance in axial view, appendicolith, periappendiceal fluid, prominent echogenic periappendiceal fat
  • CT
    • First choice for adult males and nonpregnant women with equivocal cases
    • Women derive the greatest benefit from preoperative imaging (lower neg appy rate)
    • Contrast (both PO and IV) is unnecessary but typically ordered
  • MRI
    • When unable to identify appendix in children or pregnant women