Summary

• Ultrasound is the diagnostic method of choice in pediatrics for appendicitis, and POCUS can provide rapid, real-time assessment.

• The appendix position varies, making it challenging to locate, especially in retrocecal or pelvic positions.

• Begin with the point of maximal tenderness, then use anatomical identification and graded compression to improve visualization.

• If the appendix is found, scan in both short and long axes and apply color Doppler to assess vascularity and inflammation.

• Dilation of the appendix >6mm, along with secondary findings such as wall thickening, hypervascularity, free fluid, echogenic fat, lymphadenopathy, and the presence of an appendicolith are key findings confirming appendicitis.

• PoCUS for appendicitis should be used as a rule-in test, where a positive result supports the diagnosis—helping guide immediate management decisions, but a negative scan alone does not reliably rule it out.

  • With increased scanning experience and full visualization of the appendix from base to tip, the reliability of PoCUS as a rule-out tool may improve, but this requires a high level of proficiency.