see: [Sonography of acute appendicitis](x-devonthink-item://8B966DF8-840E-4BA9-9C89-10DBB3CC8285) > Look out for the [SPASMS](https://www.predict.org.au/projects/spasms/) study on paediatric appendicitis scores in Australia, not yet published as of June 2025 DDx: ectopic, TOA, mittelschmerz, crohn's, mesenteric adenitis, # clinical signs | sign | description | | --------- | ------------------------------------------------------------------------------------------------------------------------------------------ | | Rovsing | RLQ pain with palpation of LLQ | | obturator | RLQ pain with internal and external rotation of the flexed right hip → suggests inflammed appendix is located deep in right hemipelvis | | psoas | RLQ pain with extension of right hip or with flexion of right hip against resistance; suggests appendix is along course of R psoasi | | Dunphy | sharp pain in RLQ elicited by a voluntary cough | | markle | pain in certain area of abdomen when the standing patient drops from standing on toes to the heels with a jarring landing (74% sensitive) | # Alvarado score - migration - 1 - anorexia - 1 - nausea/vomiting - 1 - RLQ tender - 2 - rebound pain - 1 - fever - 1 - leukocytosis >10k - 2 - left shift - 1 score ≥7 likely appendicitis # CT example #radiology ![[Pasted image 20241031010513.png]] CT shows: - complex mass in caecum - thickening bowel wall - fecalith - free air under diaphragm - free air in the appendix - free air abdomen - inflammatory changes in cecum **ruptured appendix** ## more CT examples ![[Pasted image 20241031011354.png|A= dilated appendix with wall thickening and central appendicolith, B = surrounding fat stranding]] ![[Pasted image 20241031011433.png|discrete abscess from appendiceal perforation, with periappendiceal fat stranding]] ![[Pasted image 20241031011631.png|non-contrast CT showing enlarged, dilated appendix distal to hyperattenuated faecolith in the base of the appendix. fat stranding around appendix seen.]]