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Insights Imaging. 2013 Dec;4(6):741-51. doi: 10.1007/s13244-013-0275-3. Epub 2013 Aug 31.

Ultrasound assessment of acute appendicitis in paediatric patients: methodology and pictorial overview of findings seen.

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NHS Grampian, In-Patient Radiology Department, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, UK,


Acute appendicitis is a common surgical emergency in the paediatric population. Computed tomography (CT) has been shown to have high accuracy and low operator dependence in the diagnosis of appendicitis. However, with increased concerns regarding CT usage in children, ultrasound (US) is the imaging modality of choice in patients where appendicitis is suspected. This review describes and illustrates the step-wise graded-compression technique for the visualisation of the appendix, the normal and pathological appearances of the appendix, as well as the imaging characteristics of the common differentials.


• A step-wise technique improves the chances of visualisation of the appendix. • There are often several causes for the non-visualisation of the appendix in children. • A pathological appendix has characteristic US signs, with several secondary features also identified. • There are multiple common differentials to consider in the paediatric patient.

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