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Operator-Dependent Techniques for Graded Compression Sonography to Detect the Appendix and Diagnose Acute Appendicitis

Jong Hwa Lee1, Yoong Ki Jeong, Kwang Bo Park, Ji Kang Park, Ae Kyoung Jeong and Jae Cheol Hwang

1 All authors: Department of Diagnostic Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, 290-3 Cheonha-Dong, Dong-Ku, Ulsan 682-714, South Korea.



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  		Fig. 1A. —11-year-old boy with acute right lower quadrant pain. Sonogram obtained with single use of graded compression technique shows low-lying cecum (C, arrows) just adjacent to urinary bladder (UB) with no visualization of appendix.

 


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  		Fig. 1B. —11-year-old boy with acute right lower quadrant pain. Sonogram obtained using upward graded compression technique shows normal compressible appendix (black arrows) just posterior to upwardly displaced terminal ileum (white arrows) and anterior to vertebral body (V). P = psoas muscle.

 


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  		Fig. 2A. —15-year-old girl with acute right lower quadrant pain. Sonogram obtained with single use of graded compression technique shows poor definition posterior to cecum (C, arrows) and terminal ileum (arrowheads) with no visible appendix. P = psoas muscle.

 


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  		Fig. 2B. —15-year-old girl with acute right lower quadrant pain. Graded compression sonogram obtained using posterior manual compression technique shows thickened appendix (white arrows) deep in relation to cecum (C, arrowheads). Black arrows point to terminal ileum. Acute suppurative appendicitis was confirmed surgically.

 


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  		Fig. 3A. —43-year-old man with acute right lower quadrant pain. Sonogram obtained with single use of graded compression technique shows no visualization of appendix. Arrows point to cecum (C).

 


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  		Fig. 3B. —43-year-old man with acute right lower quadrant pain. Graded compression sonogram obtained after patient changed position to left oblique lateral decubitus position shows medially displaced cecum (C, white arrows) with visualized normal appendix (black arrows) laterally.

 


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  		Fig. 4A. —36-year-old man with acute right lower quadrant pain. Sonogram obtained with single use of graded compression technique shows pelvic cecum with abnormal hyperechoic fat zone (F) around cecal pole (C) but no visualized appendix. P = iliopsoas muscle.

 


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  		Fig. 4B. —36-year-old man with acute right lower quadrant pain. Sonogram obtained using convex transducer shows thick hypoechoic tubular structure (arrows) with thick periappendiceal fat infiltration (F) in pelvic cavity. Acute suppurative appendicitis was confirmed surgically. C = cecum.

 


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  		Fig. 5A. —39-year-old woman with acute right lower quadrant pain. P = psoas muscle. Graded compression sonogram obtained with patient in usual position shows poorly compressible round appendix (arrows) in subcecal area on transaxial scan. Outer diameter of appendix measured 7.5 mm.

 


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  		Fig. 5B. —39-year-old woman with acute right lower quadrant pain. P = psoas muscle. Graded compression sonogram obtained after patient changed position to left oblique lateral decubitus position shows normal oval-shaped compressible appendix (arrows) displaced medially just anterior to psoas muscle.

 

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