Case
14 year old boy brought in by parents with abdominal pain. Pain was vague when it started yesterday. Today it is more persistently located in the right lower quadrant. The child has some nausea but no emesis. Temp of 100.8 °F. Exam reproduces RLQ tenderness but no rebound, no guarding.
No other concerning symptoms.
You discuss your concern for appendicitis with his parents, order labs and then bring the ED ultrasound to the bedside. You begin by scanning the area of maximal discomfort with a linear probe but do not find any abnormalities. You bring the probe down to the iliac vessels and obtain this clip.
In this clip we see the iliac vessels on the right side in far field. The center of the image, in short axis, we see a tubular structure with hypoechoic walls lying over the psoas muscle.
Obtaining a long axis view of this structure we find that is blind, ending and non-compressible.
Measuring in short axis, we find that this structure has a diameter of 10 mm or 1 cm.
With a present history and exam consistent with appendicitis the finding of a 10 mm non-compressible, blind ending structure in the right lower quadrant makes appendicitis very likely. The on call general surgeon is called.