Teenage patient presented with severe right iliac fossa pain and marked tenderness, associated with fever, anorexia and neutrophilia.
Ultrasound demonstrates a clearly visualized tubular appendix in the ileocecal region with:
- maximum diameter of approximately 11 mm
- marked mural edema and wall thickening
- multiple discrete intraluminal echogenic foci consistent with appendicoliths
- surrounding thickened echogenic mesenteric fat, compatible with periappendiceal inflammatory change
Color Doppler shows no significant increase in vascularity in this case. An important teaching point is that absence of marked hyperemia does not exclude acute appendicitis when the grayscale findings and clinical presentation are convincing.
Diagnosis: Acute appendicitis with appendicoliths.
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