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©2013 UpToDate ® Print Email Acute appendicitis ultrasound The patient is a 19-year-old female who presented to the emergency department with right lower quadrant pain. The gray scale ultrasound of the appendix is projected in the longitudinal (A) and transverse planes (B). A noncompressible appendix measures almost 20 mm in diameter, consistent with a diagnosis of acute appendicitis. The echogenic mucosal and submucosal portions of the wall have become discontinuous (red arrows) suggesting disruption as a result of sloughing. Luminal air (yellow arrows) results in posterior shadowing.