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Point-of-care ultrasound in the assessment of appendicitis
  1. Michael Jarvis Boyle1,
  2. Margaret Lin-Martore2,
  3. Sally Graglia1
  1. 1 Emergency Medicine, University of California San Francisco, San Francisco, California, USA
  2. 2 Departments of Emergency Medicine and Pediatrics, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Michael Jarvis Boyle, Emergency Medicine, University of California San Francisco, San Francisco, CA 94143-0203, USA; michael.boyle{at}

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Case presentation

A 15-year-old boy presents to the ED with 1 day of periumbilical non-radiating abdominal pain. The pain, described as a stinging sensation, started gradually 1 day prior to presentation after eating lunch and increased to an intensity of 8 out of 10 at its worst over the day. The patient reports that the pain has since improved to 4 out of 10. He does not have fevers, chills, anorexia, nausea, emesis, urinary symptoms, stool changes, testicular pain or swelling, and prior abdominal surgery. The patient has no significant medical or surgical history, takes no medications and has no allergies.

He is afebrile with other triage vital signs notable for a BP of 135/77 mm Hg, low-grade tachycardia with an HR of 101 beats/min, a normal RR of 18 breaths/min and a normal oxygen saturation of 100% on room air. On physical examination, he is a well-appearing adolescent boy lying in bed in no acute distress. He is breathing comfortably, and his cardiovascular examination reveals strong radial pulses with a regular rate and rhythm, and warm extremities. He has normal bowel sounds. On palpation, his abdomen is soft and flat, but he has tenderness at McBurney’s point. There is voluntary guarding, but no rigidity or rebound tenderness. Deep palpation in the left lower quadrant reproduces his pain in the right lower quadrant (RLQ) (Rovsing’s sign). On further evaluation, he has no inguinal hernia, and his testicles are neither swollen nor tender. He has no costovertebral angle tenderness. His skin is warm and dry.

A complete blood count reveals no leucocytosis, and a comprehensive metabolic panel including liver function tests is without abnormalities. Inflammatory markers are not obtained. His urine has no occult blood, leucocyte esterase or nitrites.

What are the indications for evaluation of the appendix with point-of-care ultrasound (POCUS)?

History and physical examination alone are often insufficient to rule in or rule out paediatric appendicitis, so …

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  • Handling editor Simon Carley

  • Contributors MJB wrote this article and was the primary physician who saw the patient in this case. ML-M was MJB's attending physician during this patient encounter. ML-M and SG reviewed and provided feedback on the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.