Use a graded compression technique with the linear probe.

Start with the marker dot cephalic, or at

patient right. Find area of maximal tenderness; gradually compress to push bowel contents out of
the way. Seek iliac vessels and psoas musclesthe appendix is anterior. You may need to scan
through a fair portion of the right lower quadrant to identify the anatomy. A normal appendix is
6mm in diameter or less, compressible and has peristaltic activity; however a normal appendix is not
always seen. Diseased tissue should once again be non-compressible and may have signs of edema
(confirmable with increased flow with Doppler). Free fluid, a phlegmon or inflammatory fat are all
specific signs of appendicitis, even without a dilated, rigid structure. These are particularly sensitive
when multiple are present (Estey 2013, Wiersma 2009) although any one is 90% specific (Ross
2014). You might see and appendicolith which shadows akin to a gallstone.