Acute appendicitis ultrasound

The patient is a 19-year-old female who presented to the emergency department with right lower quadrant pain. The gray scale ultrasound of the appendix is projected in the longitudinal (A) and transverse planes (B). A noncompressible appendix measures almost 20 mm in diameter, consistent with a diagnosis of acute appendicitis. The echogenic mucosal and submucosal portions of the wall have become discontinuous (arrows) suggesting disruption as a result of sloughing. Luminal air (arrowheads) results in posterior shadowing.