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Findings of acute appendicitis of ultrasound:

 Visualization of noncompressible appendix as a blind-ending tubular a peristaltic structure (seen

only in 2% of normal adults, but in 50% of normal children)
 Laminated wall with target appearance of 6 mm in total diameter on cross section (81%
SPECIFIC)/mural wall thickness 2 mm
 Lumen may be distended with anechoic/hyperechoic material
 Pericecal/periappendiceal fluid
 Increased periappendiceal echogenicity (= infiltration of mesoappendix/pericecal fat)
 Enlarged mesenteric lymph nodes
 Loss of wall layers = gangrenous appendix

False-negative US:

 Failure to visualize appendix

 Inability of adequate compression
 Aberrant location of appendix (eg, retrocecal)
 Appendiceal perforation
 Early inflammation limited to appendiceal tip

False-positive US:

 Normal appendix mistaken for appendicitis

 Alternate diagnosis: Crohn disease, pelvic inflammatory disease, inflamed Meckel diverticulum
 Spontaneous resolution of acute appendicitis

5. BARIUM ENEMA

A barium enema is an x-ray test where liquid barium is inserted into the colon from the anus to
fill the colon. This test can, at times, show an impression on the colon in the area of the appendix where
the inflammation from the adjacent inflammation impinges on the colon. Barium enema also can
exclude other intestinal problems that mimic appendicitis, for example Crohn's disease.

6. COMPUTERIZED TOMOGRAPHY (CT) SCAN

In patients who are not pregnant, a CT Scan of the area of the appendix is useful in diagnosing
appendicitis and peri-appendiceal abscesses as well as in excluding other diseases inside the abdomen
and pelvis that can mimic appendicitis.

CT findings of normal appendix

 Visualized in 67-100%.
 At posterior-medial aspect of cecum.
 Diameter of up to 10 mm.