Master the graded-compression ultrasound technique - the cornerstone of successful appendicitis imaging.
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Graded compression is a systematic technique that uses progressive probe pressure to displace bowel gas and improve visualization of the appendix and surrounding structures.
Position the patient supine with slight right hip elevation. This helps displace bowel gas away from the right lower quadrant.
Use a high-frequency linear transducer (7-12 MHz) for optimal resolution. In larger patients, consider a lower frequency curvilinear probe.
Begin with light pressure to identify the cecum and ileocecal valve. The appendix typically arises from the posteromedial aspect of the cecum.
Gradually increase probe pressure to displace bowel gas. Use slow, steady pressure - not sudden force. This is the key to successful visualization.
Scan in both transverse and longitudinal planes. Follow the cecum to locate the appendix. A normal appendix is compressible and measures <6mm in diameter.
Capture images in both planes showing the appendix or documenting why it cannot be visualized. Measure the maximum outer diameter.