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Pediatric ultrasound protocol checklists — Appendix · Intussusception · Pyloric · Kidneys · Spine · Hips · Neuro
Appendix Protocol Checklist
Ask the patient/caregiver to point to the area of maximal tenderness before scanning — guides initial transducer placement.
High-frequency linear transducer provides best resolution for appendix identification in children.
Graded compression is the cornerstone technique. Compress gradually to displace bowel loops and identify the appendix arising from the cecal tip.
The cecum is identified as a blind-ending bowel loop in the RIF. The appendix arises from the posteromedial cecal wall, 2–3 cm below the ileocecal valve.
Normal: ≤6 mm. Appendicitis: >7 mm. Measure outer wall to outer wall in the transverse plane at the widest point.
A non-compressible appendix >7 mm with periappendiceal fat hyperechogenicity = appendicitis until proven otherwise.
An appendicolith is present in ~30% of appendicitis cases. Its presence increases the risk of perforation.
Periappendiceal fat stranding = inflammatory change. Even with a borderline appendix diameter, fat stranding increases specificity for appendicitis.
Small amount of free fluid in the RIF is common with appendicitis. Large or complex free fluid suggests perforation.
A non-visualised appendix with clinical suspicion for appendicitis should be reported as 'appendix not identified — CT recommended'.
In children, mesenteric adenitis is the most common alternative diagnosis. In girls, assess right ovary for torsion or cyst.