# Acute appendicitis I

## Metadata
- Content type: Blog
- Canonical URL: https://123sonography.com/blog/acute-appendicitis-i
- Published: January 20, 2010
- Last updated: July 14, 2022

## Overview
Imaging from a man with right lower quaderant pain reveals a bullseye shaped structue with increased blood flow at the area of maximal tenderness, consistent with a finding of acute appendicitis.

## Authors
- [P.K. Srivastava, MD](/speaker/108)

## Content
###

*First published on SonoWorld*

Case Presentation
A 26 year old man presents with acute onset pain in the right iliac fossa. An ultrasound was performed

![Transverse image of the right iliac fossa](https://123sonography.com/sites/default/files/styles/article_image/public/image/images/Transverse%20image%20of%20the%20right%20iliac%20fossa.jpg?itok=Ft33vFlI "Transverse image of the right iliac fossa") Caption: Transverse image of the right iliac fossa | Description: There is a fluid-filled, distended, non-compressible tubular structure seen in the right iliac fossa. The walls of this tubular structure appear thickened. This area was tender with transducer pressure. The surrounding mesenteric fat appears highly echogenic. ![Transverse color Doppler image](https://123sonography.com/sites/default/files/styles/article_image/public/image/images/Transverse%20color%20Doppler%20image.jpg?itok=YSIVi9sP "Transverse color Doppler image") Caption: Transverse color Doppler image | Description: A part of the wall of the tubular structure shows increased vascularity, suggestive of an inflammatory process. ![Power Doppler image](https://123sonography.com/sites/default/files/styles/article_image/public/image/images/Power%20Doppler%20image.jpg?itok=CakJEBej "Power Doppler image") Caption: Power Doppler image | Description: This image also demonstrates the increased vascularity seen in parts of the wall. Other areas of the wall show no flow at all. ![3D appearance of the appendix](https://123sonography.com/sites/default/files/styles/article_image/public/image/images/3D%20appearance%20of%20the%20appendix.jpg?itok=WSqgpIhy "3D appearance of the appendix") Caption: 3D appearance of the appendix | Description: The 3D rendering depicts good surface morphology. Some parts of the wall of the appendix shows necrosis, which corresponds to areas of avascularity seen on the color and power Doppler scans. ## Differential Diagnosis

Acute appendicitis

## Final Diagnosis

Acute appendicitis

## Discussion

Hyperemia, when demonstrated in the wall of the appendix, is a sensitive indicator of inflammation and the case demonstrated here illustrates this feature. It also shows all the other classical features of acute appendicitis.

Case References 1. Lim HK, Lee WJ, Kim TH, Namgung S, Lee SJ, Lim JH. Appendicitis: usefulness of color Doppler US. Radiology. 1996 Oct;201(1):221-5.
- Quillin SP, Siegel MJ. Appendicitis: efficacy of color Doppler sonography. Radiology. 1994 May;191(2):557-60.