Acute appendicitis is the most frequently suspected acute abdominal disorder in the Emergency Department and the most common indication for emergency abdominal surgery [1]. Clinical evaluation of acute appendicitis is difficult in pregnant patients: signs and symptoms may be obscured and the appendix may be displaced by the gravid uterus (so that pain and tenderness may not be prominent in the right lower quadrant). In this population, history and clinical finding of acute appendicitis are not classic and may be confused with a non-surgical disease...

During a 16-month period, we retrospectively retrieved and reviewed sonographic examinations performed on 68 pregnant women with clinically suspected acute appendicitis. (Sep. 2008 – Feb. 2010). Study subjects' average age was 27.3, with an average gestational age of 26 weeks. All patients had abdominal pain. Sonography was the first imaging modality employed. Surgery or clinical follow-up was the gold standard for the evaluation of sonographic performance. The scan was performed on a SIEMENS Acuson 2000 Diagnostic Ultrasound System with 4C1 &9L4 transducers (Multi-D). All examinations...

In the 68cases included in our series, 2 patients (2.9%) had nondiagnostic exams: one was obese and over 34 weeks pregnant and other was 36 weeks pregnant. Of the 66 remaining cases, 4 patients (6.1%) had positive sonographic findings of acute appendicitis. Sonographic findings were correlated with surgical findings and clinical follow-up. The diagnosis was confirmed intraoperatively in all 4 patients (100%). In the 62 patients with negative sonographic findingsfor acute appendicitis, the result for 1 patient (1.6%) proved false-negative (surgery confirmed acute appendicitis), whereas...

Our experience suggests that gray-scale graded compression ultrasonography in the left lateral decubitus position, in addition to color Doppler imaging, is a highly accurate method for the diagnosis of acute appendicitis in pregnant women and should be performed as the first imaging test. We present the optimal study protocol, which allows not only to selectively examine the right lower quadrant of the abdomen, but to diagnose other common pathologic conditions in pregnant women as well.

1. Tracey M, Fletcher HS. Appendicitis in pregnancy. Am Surg 2000;66:555–559. 2. Mourad J, Elliott JP, Erickson L, et al. Appendicitis in pregnancy: new information that contradicts long-held clinical beliefs. Am J Obstet Gynecol 2000;182:1027–1029. 3. Andersen B, Nielsen TF. Appendicitis in pregnancy: diagnosis, management and complications. Acta Obstet Gynecol Scand 1999;78:758–762. 4. Puylaert JB. Acute appendicitis: US evaluation using graded compression. Radiology 1986;158:355–360. 5. Lim HK, Bae SH, Seo GS. Diagnosis of acute appendicitis in pregnant women: value of sonography. AJR Am J Roentgenol...

Natalia Kokhanovsky MD, Department of Radiology, Hillel Yaffe Medical Center, Hadera, [email protected] Abdel-Rauf Zeina MD,Department of Radiology, Hillel Yaffe Medical Center, Hadera, [email protected] Nadir Reindorp MD,Department of Radiology, Hillel Yaffe Medical Center, Hadera, [email protected] Alicia Nachtigal MD,Department of Radiology, Hillel Yaffe Medical Center, Hadera, [email protected]