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Journal of Ultrasound in Medicine, Vol 10, Issue 11 625-628, Copyright © 1991 by American Institute of Ultrasound in Medicine
The gas-containing appendix: potential sonographic pitfall in the diagnosis of acute appendicitis
A. Poljak, R. B. Jeffrey Jr and M. E. Kernberg
Department of Diagnostic Radiology, Stanford University School of Medicine, California 94305.
The presence of gas within the appendix on plain abdominal radiographs is
nonspecific and may or may not be associated with acute appendicitis. This
finding, however, has not previously been reported with graded compression
sonography of the right lower quadrant. Gas within the appendix was
identified in four of 154 patients with a visualized appendix. All four
patients had surgically confirmed acute appendicitis. Diagnostic
difficulties were encountered in three of these four patients. In two
patients, the findings were misinterpreted as an extraluminal gas-forming
periappendiceal abscess. In an additional patient, the gas-filled appendix
was initially mistaken for a segment of normal terminal ileum. The
gas-filled appendix is a potential pitfall in the sonographic diagnosis of
acute appendicitis. However, if other diagnostic criteria are met, gas
within the appendix should not preclude establishing a sonographic
diagnosis of appendicitis.
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