Descubrimientos En Apendicitis Aguda : Ecografía

Findings:  Viable intrauterine twin gestations measuring approximately 10 weeks each for age. In the right lower quadrant there is a blind-ended tube without peristalsis. It measures 7 mm in diameterwith heterogeneous mixed-echoic material within the lumen. Wall layers not well visualized. Associated hypoechoic fluid is adjacent to it. A small round hyperechoic nodule is identified at theproximal end. Tube is noncompressable and tender when palpated.

Diagnosis:  Acute Appendicitis

Acute appendicitis
The incidence worldwide is 7-12%.   The condition begins with obstruction ofappendiceal lumen.  Then mucosal secretions continue, increasing the intraluminal pressure and compromising venous return.  The mucosa becomes hypoxic and ulcerates.  Bacterial infection ensues ultimatelywith gangrene and perforation.  Obstruction can occur by lymphoid hyperplasia, fecolith, foreign body, stricture, tumor or parasite.  In nonpregnant patients, false positives and false negatives average20%.
The clinical picture begins with transient crampy pain in the periumbilical area associated with nausea and vomiting.  Then as the inflammation extends to the serosa, the pain shifts to the RLQand peritoneal signs may ensue.  In pregnancy, the gravid uterus pushes the normal position superiorly making clinical findings less reliable.  The differential diagnosis for adnexal pain also becomesmore complex.  Clinical misdiagnosis occurs most frequently in young women as there are other gynecologic conditions such as PID, ovarian cysts and torsion.  Complications (perforation in 13-30%) mayjeopardize pregnancy.  Early pregnancy complicates the clinical scenario as imaging options are few.
Radiologic Overview of the Diagnosis:  Clearly in this scenario, the first option for imaging isultrasound.  Sensitivity is 77-94%.  Specificity is 78-96%.  Inadequate study occurs in 4% due to noncompressability of the RLQ.  Features include:
Visualization of noncompressible appendix as a...