In this blog, we briefly discuss the role and limitations of Point-of-care ultrasound (POCUS) in diagnosing acute appendicitis (AA). We will review the normal ultrasound appearance of the appendix and some typical ultrasound findings you may encounter in acute appendicitis. appendicitis

Approximately 17.7 million cases of acute appendicitis were estimated worldwide in 2019, resulting in over 33,400 deaths. As the term indicates, acute appendicitis is the acute inflammation of the appendix. The patient may present with abdominal pain in the periumbilical region or the McBurney’s point with tenderness in the right lower quadrant, accompanied by nausea, vomiting, and fever. Sometimes the pain could be in an atypical location. Even though a CT scan is very sensitive to diagnose acute appendicitis, ultrasound should be preferred due to its lower cost and absence of ionizing radiation. Several published studies have concluded varying results about the sensitivity of ultrasound as an effective diagnostic tool for AA. According to one publication by Fabio Pinto et al., the accuracy of ultrasound in the diagnosis of acute appendicitis varies from 44% – 99%, and the specificity range is from 47% – 99%. That is a substantial range in sensitivity and specificity and can be attributed to various factors such as obesity, lack of operator skill, increased bowel gas, and anatomical variants. Despite the challenges, ultrasound should be the first-line diagnostic tool of choice for the reasons mentioned above. Additionally, it is easy to access and available at the bedside. The ultrasound exam should be performed in the supine position. Recent studies have also recommended additional patient positions if the appendix is not visible in the supine position. The transducer of choice should be a curvilinear low-frequency transducer or even a high-frequency linear transducer in thin subjects or some pediatric patients. In obese patients, you would have to use a low-frequency convex transducer. Start scanning by placing the transducer over the region of maximum tenderness. The goal should be to identify the appendix. Alternatively, you can begin scanning with the transducer over the area of the mid ascending colon and try to locate the cecum and appendix. Bowel gas may