Abstract Ultrasonography (USG) has become a valuable initial and readily available imaging modality in assessing appendicitis. Visualization of the appendix can be challenging, especially when it is retrocecal. We described a novel USG technique wherein changing patients' position leads to improve visualization of inflamed appendix. Our study aimed to evaluate suspected patients of acute appendicitis using USG and assess improved visualization of the appendix due to positional change from supine to left lateral decubitus position. Patients with abdominal pain with the clinical suspicion of acute appendicitis referred for USG over a period of 2 years, from January 2023 to December 2024, were prospectively evaluated. The patients were divided into two groups: the first group, where routine USG with the graded compression method was employed (January 1, 2023 to December 31, 2023), and the second group, where USG with positional change was performed (January 1, 2024 to December 31, 2024). In both groups, computerized tomography (CT) referral rates were also compared. All patients diagnosed with acute appendicitis underwent surgery, and histopathological confirmation was taken as the gold standard. A total of 197 patients of abdominal pain were evaluated during the period, January 1, 2023 to December 31, 2023. Twenty-six positive cases were found during this period, an inflamed appendix was visualized on USG in 80.8% cases (21 cases), with diagnosis on CT in 19.2% cases (5 cases). A total of 222 patients of abdominal pain were evaluated during the period January 1, 2024 to December 31, 2024. Thirty-one positive cases were found during this period, an inflamed appendix was visualized on USG in 96.8% (30 cases), the CT referral rate was 3.2% (1 case). Significant association was found when USG was performed with positional changes vis-a-vis conventional method in the diagnosis of appendicitis (p-value 0.04). In case of nonvisualized appendix, utilization of the positional method (USG in left lateral decubitus position) significantly improves the visualization rates of the appendix (especially retrocecal appendix) with a reduction in CT referrals.
Paliwal et al. (Tue,) studied this question.