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Graded Compression Sonography with Adjuvant Use of a Posterior Manual Compression Technique in the Sonographic Diagnosis of Acute Appendicitis

Jong-Hwa Lee1, Yoong Ki Jeong, Jae Cheol Hwang, Soo Youn Ham and Seoung-Oh Yang

1 All authors: Department of Diagnostic Radiology, Ulsan University Hospital, Ulsan University College of Medicine, 290-3 Junha-Dong, Dong-Gu, Ulsan, 682-060, Korea.



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  		Fig. 1. —Photograph shows technique of anterior graded compression sonography with adjuvant use of posterior manual compression technique.

 


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  		Fig. 2. —51-year-old man with right lower quadrant pain. Graded compression sonogram with adjuvant use of posterior manual compression technique shows compressible tubular structure of normal vermiform appendix (arrows) with inner echogenic portion and outer hypoechoic line on iliopsoas muscle (P).

 


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  		Fig. 3A. —21-year-old man with right lower quadrant pain. Graded compression sonogram shows no detectable appendix around cecum (C, arrowheads). P = iliopsoas muscle.

 


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  		Fig. 3B. —21-year-old man with right lower quadrant pain. Graded compression sonogram after adjuvant use of posterior manual compression technique shows clearly visible thickened appendix (arrows) at retrocecal location with forced compression of retrocecal space with forced medial displacement of cecum (C, arrowheads). Acute appendicitis is surgically confirmed. P = iliopsoas muscle.

 


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  		Fig. 4A. —52-year-old man with right lower quadrant pain. Graded compression sonogram shows irregular inflammatory wall thickening of cecum (c, arrows).

 


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  		Fig. 4B. —52-year-old man with right lower quadrant pain. Graded compression sonogram after adjuvant use of posterior manual compression technique shows well-defined outpouching of acute diverticulitis (D) at retrocecal location with hyperechoic peridiverticular infiltration (white arrows). Black arrows point to cecum (c).

 

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