Ultrasonography for acute appendicitis - the way it looks today

Despite sophisticated physical examination and laboratory support, diagnosis of acute appendicitis remained challenging in clinical practice with a negative appendectomy rate of 15 - 30 %. As a remarkable clue and as early as 1986, ultrasonography (US) has been proven a reliable diagnostic method that is also explicitly helpful in difficult cases with atypical presentation and enables to rule out many differential diagnoses.Recent publications emphasized the role of multidetector computed tomography (CT) resulting in a significant reduction of false negative findings at operation. Extensive as well as uncritical application of this method even in children inevitably causes substantial radiation exposure, a sequel to either pure ignorance or unqualified/inadequate performance of US in this particular situation, which in turn can be considered sequel to either egocentric or economic preponderance.Recent data shed new light on the role of US (and CT) in acute appendicitis. Therefore, 1 generation after US with graded compression was etched in stone as the method of choice for diagnosing acute appendicitis (Puylaert), a visual arousal fostering its role and performance in clinical medicine appears justified.