超声莫非氏征在怀疑急性胆囊炎的临床价值

本文报告了100例临床怀疑急性胆囊炎患者，经手术病理组织学证实为急性胆囊炎30例，70例是由非急性胆囊炎引起的上腹部疼痛，超声莫非氏征（SMS）的总准确度是85％，灵敏度80％，特异度87％，阳性预告值72．7％，阴性预告值91．1％，尽管不完全可靠，但SMS在评价怀疑急性胆囊炎的患者中是一种有用的辅助诊断方法。     

Further observations on the usefulness of the sonographic Murphy sign in the evaluation of suspected acute cholecystitis

A positive sonographic Murphy sign, the presence of maximal tenderness elicited over a sonographically localized gallbladder, has been reported to be a helpful adjunctive finding in patients with proven acute cholecystitis who are evaluated with ultrasonography. We evaluated 200 patients with right upper quadrant pain, thought to be acute cholecystitis. Results of ultrasound examinations and subsequent follow-up were tabulated. The sensitivity of the sonographic Murphy sign in acute cholecystitis was 86% with a specificity of 35%, positive predictive value of 43%, and negative predictive value of 82%. The sensitivity of the sonographic findings, including stones, gallbladder wall edema, and pericholecystic fluid collections, was 93%, a specificity of 53%. The combination of the Murphy sign accompanied by gallstones yielded a specificity of 77%. The large number of false positives, and only moderate improvement in specificity when accompanied by gallstones, makes this sign unreliable in separating acute from chronic cholecystitis. © 1995 John Wiley & Sons, Inc.     

Performance and interpretation of focused right upper quadrant ultrasound by emergency physicians

The objectives of this study were to determine the accuracy of Emergency Physicians (EP) performing focused right upper quadrant (RUQ) ultrasound, to quantify how sonographic experience affects accuracy for gallbladder pathology, and to establish the time needed to complete a focused RUQ ultrasound. A convenience sample of patients with suspected gallbladder disease received a focused RUQ ultrasound by an EP. Sonographic findings, number of previous RUQ ultrasounds performed, and time for examination completion were recorded. Each patient then had a formal RUQ ultrasound by a sonographer blinded to the focused RUQ ultrasound results. Focused RUQ and formal ultrasound findings were compared, with the exception of the sonographic Murphy sign, which was compared to pathology reports. One hundred nine patients were enrolled. Fifty-one had gallstones. Forty-nine were detected by EPs, yielding a sensitivity of 96% [95% confidence interval (CI).87-.99]. Of the 58 patients without gallstones, 51 were correctly diagnosed by EPs (specificity = 88%, 95% CI.77-.95). The sonographic Murphy sign was present during 54 emergency examinations, but in only 24 formal studies. When compared to pathology reports, the emergency sonographic Murphy sign had a sensitivity of 75% compared to the formal ultrasound sensitivity of 45% for acute cholecystitis. EPs were less accurate for other sonographic findings, and level of experience had little effect on sensitivity or specificity for detecting gallstones. Eighty-three percent of emergency studies were completed in less than 10 min. Gallstones are accurately detected by EPs in a timely fashion. Additionally, compared to the radiologist's interpretation, the EP-detected sonographic Murphy sign was more sensitive for diagnosing acute cholecystitis.     

Association of clinical and laboratory variables with ultrasound findings in right upper quadrant abdominal pain

BACKGROUND: The purpose of this study was to determine how laboratory values and physical examination findings correlate with ultrasound findings in the setting of right upper quadrant pain. METHODS: Patients undergoing emergent ultrasound for the evaluation of biliary disease between November 1999 and April 2000 were included. Physical examination findings, laboratory data, and ultrasound results were variables. Logistic regression was performed. Ultrasound diagnosis of acute cholecystitis, cholelithiasis, and normal biliary tract were end points. One hundred seventy-seven patients were enrolled. RESULTS: Forty-two percent were diagnosed with acute cholecystitis, 30.5% with cholelithiasis, and 27.1% with normal biliary tract. Alkaline phosphatase, Murphy sign, white blood cell count, and total bilirubin were statistically significant predictors of acute cholecystitis. A Murphy sign was defined as arrest of inspiration with pressure over the right upper quadrant. CONCLUSIONS: The findings from this study allow clinicians to apply objective significance to laboratory data and physical examination findings in patients with suspected gallstone disease. The data can be applied to create a predictive model.     

Diagnostic values of gallbladder hyperperfusion and the rim sign in radionuclide angiography and hepatobiliary imaging

The diagnostic values of hyperperfusion to the gallbladder fossa and the rim sign were retrospectively evaluated in 24 histopathologically proven cases of gallbladder disease. Although 12 of 13 patients (92%) with acute cholecystitis had nonvisualization of the gallbladder, the positive predictive value with this finding was 71%. However, when the finding was associated with hyperperfusion to the gallbladder fossa or the rim sign, the positive predictive value with both (90%) was markedly increased compared to the prevalence ratio of 54%. Such a combination could be useful for preserving a high positive predictive value in the diagnosis of acute cholecystitis.     

Color Doppler imaging of the gallbladder wall in acute cholecystitis: sonographic<+>–<+>pathologic correlation

Background: The purpose of this study was to evaluate the usefulness of color Doppler imaging (CDI) in suspected cases of acute cholecystitis. Methods: Twenty-two patients suspected of having acute cholecystitis were prospectively evaluated over a 12-month period using gray-scale and color Doppler technique. Gallbladder wall thickness was greater than 2 mm in all patients included in the study. Pathologic correlation was obtained in 17 patients, with clinical or sonographic follow-up in five for a period of 6<+>–/011001/months. CDI was considered positive only if the mid to fundal wall demonstrated flow. Sonographic Murphy's sign and laboratory values were recorded. Results: Eight patients had acute cholecystitis. All had positive color Doppler flow. Wall thickness in these patients ranged between 4 and 10 mm. Three patients with necrotizing acute cholecystitis had no flow within 6<+>–<+>8-mm walls. Six patients with pathologically proven chronic cholecystitis had no evidence of increased flow within thickened walls. Five patients with presumed chronic cholecystitis (thickened wall without increased color flow) were treated medically, and their symptoms resolved. CDI was more sensitive in predicting acute cholecystitis than was the sonographic Murphy's sign and/or laboratory values. Conclusion: CDI demonstrates hyperemic changes in thickened gallbladder walls and is an important adjunct in the diagnosis of acute cholecystitis. Received: 3 February 1995/Accepted: 24 March 1995     

Point-of-care ultrasound diagnosis of pediatric cholecystitis in the ED

Objective

The diagnosis of cholecystitis or biliary tract disease in children and adolescents is an uncommon occurrence in the emergency department and other acute care settings. Misdiagnosis and delays in diagnosing children with cholecystitis or biliary tract disease of up to months and years have been reported in the literature. We discuss the technique and potential utility of point-of-care ultrasound evaluation in a series of pediatric patients with suspected cholecystitis or biliary tract disease.

Methods

We present a nonconsecutive case series of pediatric and adolescent patients with abdominal pain diagnosed with cholecystitis or biliary tract disease using point-of-care ultrasound. The published sonographic criteria is 3 mm or less for the upper limits of normal gallbladder wall thickness and is 3 mm or less for normal common bile duct diameter (measured from inner wall to inner wall) in children. Measurements above these limits were considered abnormal, in addition to the sonographic presence of gallstones, pericholecystic fluid, and a sonographic Murphy's sign.

Results

Point-of care ultrasound screening detected 13 female pediatric patients with cholecystitis or biliary tract disease when the authors were on duty over a 5-year period. Diagnoses were confirmed by radiology imaging or at surgery and surgical pathology.

Conclusions

Point-of-care ultrasound to detect pediatric cholecystitis or biliary tract disease may help avoid misdiagnosis or delays in diagnosis in children with abdominal pain.     

Discrimination of gangrenous from uncomplicated acute cholecystitis: Accuracy of CT findings

In acute cholecystitis, the presence of gangrene is associated with higher morbidity and mortality and necessitates open surgical intervention rather than laparoscopic cholecystectomy. As Murphy’s sign may be absent, gangrene may not be detected ultrasonographically. This retrospective study evaluated indications of acute gangrenous cholecystitis on computed tomography (CT) in 25 patients, who were proven as having acute cholecysitis surgically and pathologically within 3 days of pre-operative CT. The CT images were reviewed by two board-certified radiologists blind to the initial CT report. Acute gangrenous cholecystitis was significantly correlated with the CT signs of perfusion defect (PD) of the gallbladder wall (P = 0.02), pericholecystic stranding (PS) (P = 0.028), and no-gallstone condition (No-ST) (P = 0.026). The presence of PD was associated with acute gangrenous cholecystitis with a relatively high accuracy (80%), a sensitivity of 70.6%, a specificity of 100%, a positive predictive value (PPV) of 100%, and a negative predictive value (NPV) of 61.5%. The combination CT signs of PD or No-ST improved the accuracy for acute gangrenous cholecystitis to 92%, with a sensitivity, specificity, PPV, and NPV of 88.2%, 100%, 100%, and 80%, respectively. Other CT signs were highly specific for acute gangrenous cholecystitis but of low sensitivity, including mucosal hemorrhage, mucosal sloughing, wall irregularity, pericholecystic abscess, gas formation, and portal venous thrombosis. CT was found to accurately diagnose acute cholecystitis, with the presence of PD, PS, or No-ST significantly correlated with that of gangrenous change. Thus, CT is useful in the preoperative detection of acute gangrenous cholecystitis.     

Selective Use of Ultrasonography for the Detection of Pneumoperitoneum

OBJECTIVE: Whether ultrasonography is superior to plain radiography for the detection of pneumoperitoneum is unknown. The goal of this study was to determine the value of ultrasonography for the detection of pneumoperitoneum. METHODS: One hundred thirty-two patients with suspected hollow-organ perforation were prospectively selected for study. All 132 patients received ultrasonography, upright chest radiography, and left lateral decubitus abdominal radiography examinations. The diagnostic accuracies of chest and abdominal radiographs for the detection of pneumoperitoneum were compared with corresponding values from ultrasonography. RESULTS: Of the 125 patients who underwent laparotomy, 121 patients had hollow-organ perforation, three patients had perforated appendicitis, and one patient had acute cholecystitis. For the diagnosis of pneumoperitoneum, ultrasonography demonstrated a sensitivity of 93%, a specificity of 64%, a positive predictive value of 97%, a negative predictive value of 44%, and an accuracy of 90%. Plain radiography revealed a sensitivity of 79%, a specificity of 64%, a positive predictive value of 96%, a negative predictive value of 21%, and an accuracy of 77%. CONCLUSIONS: Ultrasonography is a more sensitive diagnosing modality than plain radiography for the diagnosis of pneumoperitoneum. The authors suggest that ultrasonography was a useful diagnostic modality when plain radiographs failed to reveal pneumoperitoneum among patients with suspected hollow-organ perforation.     

Sonographic evaluation of isolated abnormal axillary lymph nodes identified on mammograms.

OBJECTIVE: To evaluate the role of sonography in evaluation of abnormal axillary lymph nodes identified in patients with otherwise negative or benign findings on mammography. METHODS: For 3 years 2 months, we retrospectively reviewed 30 consecutive cases that had undergone sonographic evaluation for abnormal axillary lymph nodes identified in patients whose mammograms had an American College of Radiology Breast Imaging Reporting and Data System final assessment of 1 or 2. Mammographic and sonographic features of the lymph nodes were analyzed and correlated with the histologic diagnosis in patients undergoing biopsy. Patients who did not undergo biopsy had clinical or imaging follow-up. RESULTS: Twenty of the 30 patients studied had an abnormal sonographic appearance. Biopsy was recommended in 17 of the 20 patients on the basis of an abnormal sonographic appearance. In the remaining 3 patients, there was an underlying cause for lymphadenopathy, and these patients underwent clinical and sonographic follow-up. Eighteen patients underwent biopsy, including 1 patient with normal findings on sonography. Ten of these patients had malignant histologic findings: 6 were metastatic adenocarcinoma; 1, poorly differentiated sarcoma, and 3, lymphoma. The remaining 8 patients had benign histologic findings. The nonbiopsy group had clinical and or imaging follow-up (mean, 17.6 months; range, 6-25 months). The sensitivity (true-positive/true-positive + false-negative) of sonography for assessment of suspected abnormal lymph nodes in the patients studied was 100% (10 of 10); specificity (true-negative/true-negative + false-positive), 50% (10 of 20); positive predictive value (true-positive/true-positive + false-positive) for malignancy based on the presence of 2 or more abnormal sonographic features, 50% (10 of 20); and negative predictive value, 100%. CONCLUSIONS: Sonography is useful in further characterization of isolated abnormal axillary lymph nodes identified on mammography. Sonographic evaluation helps improve the specificity of imaging evaluation in assessment of these lymph nodes.     

Prospective validation of the bedside sonographic acute cholecystitis score in emergency department patients

BackgroundAcute cholecystitis can be difficult to diagnose in the emergency department (ED); no single finding can rule in or rule out the disease. A prediction score for the diagnosis of acute cholecystitis for use at the bedside would be of great value to expedite the management of patients presenting with possible acute cholecystitis. The 2013 Tokyo Guidelines is a validated method for the diagnosis of acute cholecystitis but its prognostic capability is limited. The purpose of this study was to prospectively validate the Bedside Sonographic Acute Cholecystitis (SAC) Score utilizing a combination of only historical symptoms, physical exam signs, and point-of-care ultrasound (POCUS) findings for the prediction of the diagnosis of acute cholecystitis in ED patients.MethodThis was a prospective observational validation study of the Bedside SAC Score. The study was conducted at two tertiary referral academic centers in Boston, Massachusetts. From April 2016 to March 2019, adult patients (≥18 years old) with suspected acute cholecystitis were enrolled via convenience sampling and underwent a physical exam and a focused biliary POCUS in the ED. Three symptoms and signs (post-prandial symptoms, RUQ tenderness, and Murphy's sign) and two sonographic findings (gallbladder wall thickening and the presence of gallstones) were combined to calculate the Bedside Sonographic Acute Cholecystitis (SAC) Score. The final diagnosis of acute cholecystitis was determined from chart review or patient follow-up up to 30 days after the initial assessment. In patients who underwent operative intervention, surgical pathology was used to confirm the diagnosis of acute cholecystitis. Sensitivity, specificity, PPV and NPV of the Bedside SAC Score were calculated for various cut off points.Results153 patients were included in the analysis. Using a previously defined cutoff of ≥ 4, the Bedside SAC Score had a sensitivity of 88.9% (95% CI 73.9%–96.9%), and a specificity of 67.5% (95% CI 58.2%–75.9%). A Bedside SAC Score of < 2 had a sensitivity of 100% (95% CI 90.3%–100%) and specificity of 35% (95% CI 26.5%–44.4%). A Bedside SAC Score of ≥ 7 had a sensitivity of 44.4% (95% CI 27.9%–61.9%) and specificity of 95.7% (95% CI 90.3%–98.6%).ConclusionA bedside prediction score for the diagnosis of acute cholecystitis would have great utility in the ED. The Bedside SAC Score would be most helpful as a rule out for patients with a low Bedside SAC Score < 2 (sensitivity of 100%) or as a rule in for patients with a high Bedside SAC Score ≥ 7 (specificity of 95.7%). Prospective validation with a larger study is required.     

全身免疫炎症指数对急性胆囊炎的预测价值

目的 探讨术前全身免疫炎症指数（systemic immune-inflammation index,SII）预测急性胆囊炎的临床价值。方法 收集2020年8月至2023年11月于复旦大学附属金山医院行胆囊手术的297例胆囊炎患者数据,分为包括轻重度胆囊炎的急性胆囊炎组以及慢性胆囊炎组,进行组间比较。绘制ROC曲线评估SII以及NLR（neutrophil-to-lymphocyte ratio,NLR）的预测价值。结果 与轻度胆囊炎组相比,重度胆囊炎组SII及NLR显著升高（P＜0.001）,最佳截断值为1056.59时,SII预测重度胆囊炎的AUC为0.768,敏感性为77%,特异性为67.5%。最佳截断值为4.65时,NLR预测重度胆囊炎的AUC为0.779,敏感性为82.3%,特异性为62.3%。SII对重度胆囊炎的预测性能与NLR无明显差异（Z=0.789,P=0.430)。与慢性胆囊炎组相比,急性组SII及NLR显著升高（P＜0.001）,最佳截断值为797.96时,SII预测急性胆囊炎的AUC为0.847,敏感性为73.2%,特异性为86.7%。最佳截断值为3.65时,NLR预测急性胆囊炎的AUC为0.869,敏感性为74.2%,特异性为89.5%。SII预测急性胆囊炎的性能与NLR无明显差异（Z=1.715,P=0.086)。结论 SII是一种良好的预测急性胆囊炎的血液学指标,与NLR预测能力相似。     

Sonographic features of acute colonic diverticulitis: the "dome sign"

PURPOSE: This study was performed to clarify the sonographic features of acute colonic diverticulitis to enable its differentiation from appendicitis. METHODS: Of 119 patients who were referred to our hospitals for lower abdominal pain between June 1997 and December 1998 and underwent sonography, 12 patients had a definitive diagnosis of acute colonic diverticulitis and 4 patients a tentative diagnosis. Seventy-eight patients were diagnosed as having acute appendicitis, confirmed by appendectomy. In the 16 patients with diagnoses of diverticulitis, the sonographic and clinical features of acute colonic diverticulitis were studied. RESULTS: Among the 12 patients with definitive diagnoses of acute colonic diverticulitis, sonographic findings included localized thickening of the colonic wall (100%) and a hemispheric mass (the "dome sign") protruding at the thickened colonic wall (100%) and consisting of a hypoechoic wall (100%) and a central echogenic area (66%). The presence of diverticula was confirmed by barium-enema x-ray study in all 12 patients. The 4 patients with tentative diagnoses of acute colonic diverticulitis all had colonic wall thickening but no dome sign. Colonoscopy revealed colitis in 3 of these patients. All 16 patients recovered with conservative treatment, without laparotomy. CONCLUSIONS: Sonography was useful for differentiating acute colonic diverticulitis from appendicitis. The sonographic finding of the dome sign seems to be specific for acute colonic diverticulitis.     

Ultrasonography by emergency physicians in patients with suspected cholecystitis

This article investigates the use of bedside abdominal ultrasonography (BAU) performed by emergency physicians (EPs) to screen patients for cholelithiasis and cholecystitis. In this prospective study EPs performed BAU on 116 patients. Agreement between BAU and formal abdominal ultrasound (FUS) performed in the radiology department for detecting cholelithiasis and cholecystitis was determined using Kappa statistics. Test characteristics of BAU for detecting cholelithiasis and acute cholecystitis were calculated. Agreement between BAU and FUS was 0.71 for cholelithiasis and 0.46 for acute cholecystitis. Test characteristics of BAU for cholelithiasis were sensitivity 92%, specificity 78%, positive predictive value (PPV) 86%, negative predictive value (NPV) 88%. Test characteristics of BAU for acute cholecystitis compared with clinical follow-up were sensitivity 91%, specificity 66%, PPV 70%, NPV 90%. BAU may be used to exclude cholelithiasis and is sensitive for cholecystitis. However, when EPs with limited experience identify cholecystitis a confirmatory test is warranted before cholecystectomy.     

Gas‐containing gallstones as a cause of the “effervescent gallbladder” sign and pneumobilia

The “effervescent gallbladder” sign, the sonographic finding of tiny echogenic foci rising from the dependent portion of the gallbladder, reminiscent of bubbles rising in a glass of champagne, has been reported previously as a finding of emphysematous cholecystitis. We report two additional cases of this unusual finding in an asymptomatic patient and in a patient with acute, gangrenous cholecystitis, confirmed in both cases by CT, to be secondary to the release of gas from gallstones. These two cases cast doubt on the sonographic sign as a pathognomonic finding of emphysematous cholecystitis. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound 41 :50–53, 2013     

Gangrenous cholecystitis: prediction with CT imaging

The aim of this study is to determine the usefulness of different patterns of gallbladder mucosal enhancement on contrast-enhanced computed tomography (CT) for differentiating between gangrenous and uncomplicated acute cholecystitis. This retrospective evaluation involved 56 patients with histopathologically proved acute cholecystitis (32 with gangrenous and 24 with uncomplicated acute cholecystitis) who had preoperative contrast-enhanced CT imaging. CT in 38 patients showed a gallbladder mucosal enhancement pattern that could be categorized into continuous, discontinuous, and/or irregular categories. In the other 18 patients, the mucosal enhancement pattern could not be classified due to lack of mucosal enhancement or inadequate mucosal enhancement. On contrast-enhanced CT evaluation, continuous and discontinuous and/or irregular mucosal enhancement patterns were seen in 20 and 18 patients, respectively. Among the 20 patients with continuous mucosal enhancement, 17 had uncomplicated acute cholecystitis. Seventeen of the 18 patients with discontinuous and/or irregular mucosal enhancement had gangrenous cholecystitis. The sensitivity and positive predictive value (PPV) of discontinuous and/or irregular mucosal enhancement in the diagnosis of gangrenous cholecystitis were 30.3% and 94.4% (17 of 18), respectively. The sensitivity and PPV of continuous mucosal enhancement in the diagnosis of uncomplicated acute cholecystitis were 30.3% and 85.5% (17 of 20), respectively. There was a statistically significant difference (p=0.0005) between the PPV of discontinuous and/or irregular (94.4%) and that of continuous (15%) mucosal enhancement for predicting gangrenous cholecystitis. The pattern of gallbladder mucosal enhancement on CT can be used as a reliable criterion for distinguishing acute, uncomplicated cholecystitis from gangrenous cholecystitis.     

Sonographic evaluation of focal asymmetric density of the breast

The purpose of this study was to examine the role of sonography in the evaluation of a focal asymmetric density of the breast in patients who subsequently underwent biopsy for this finding. During a 30-month period, the clinical, sonographic, and pathologic findings were retrospectively reviewed in 36 women who underwent biopsy for a focal asymmetric density of the breast after mammographic and sonographic workup. Sonographic evaluation of a focal asymmetric density of the breast in 36 women demonstrated a solid mass in 15, a suspected complicated cyst in two, echogenic tissue in nine women, and no focal sonographic change in 10. Excisional biopsy of the focal asymmetric density revealed infiltrating ductal cancer in seven patients (19.4%: 7/36). Two of these seven patients with breast cancer had no focal abnormality at sonographic examination. Twenty-nine patients had benign pathologic findings. In this retrospective study, the negative predictive value of sonography for breast cancer in a patient with a focal asymmetric density undergoing biopsy was found to be 89.4% (17/19). Sonographic evaluation of a focal asymmetric density is helpful, particularly to identify an underlying mass. When sonography demonstrates echogenic tissue corresponding to the focal asymmetric density, a benign process is likely; however, absence of a corresponding focal finding does not exclude malignancy. Therefore, although the negative predictive value of sonography for breast cancer in a patient with a focal asymmetric density is high, biopsy is still indicated for this mammographic finding when it is new, enlarging, or palpable, even in the absence of a suspicious sonographic finding.     

Sonography in the Evaluation of Acute Appendicitis

Objective. The purpose of this study was to evaluate the negative predictive value (NPV) of sonography in the diagnosis of acute appendicitis. Methods. Right lower quadrant sonograms of 193 patients (158 female and 35 male; age range, 3–20 years) with suspected acute appendicitis over a 1‐year period were retrospectively reviewed. Sonographic findings were graded on a 5‐point scale, ranging from a normal appendix identified (grade 1) to frankly acute appendicitis (grade 5). Sonographic findings were compared with subsequent computed tomographic (CT), surgical, and pathologic findings. The diagnostic accuracy of sonography was assessed considering surgical findings and clinical follow‐up as reference standards. Results. Forty‐nine patients (25.4%) had appendicitis on sonography, and 144 (74.6%) had negative sonographic findings. Computed tomographic scans were obtained in 51 patients (26.4%) within 4 days after sonography. These included 39 patients with negative and 12 with positive sonographic findings. Computed tomography changed the sonographic diagnosis in 10 patients: from negative to positive in 3 cases and positive to negative in 7. Forty‐three patients (22.2%) underwent surgery. The surgical findings were positive for appendicitis in 37 (86%) of the 43 patients who had surgery. Patients with negative sonographic findings who, to our knowledge, did not have subsequent CT scans or surgery were considered to have negative findings for appendicitis. Seven patients with negative sonographic findings underwent surgery and had appendicitis; therefore, 137 of 144 patients with negative sonographic findings did not have appendicitis. On the basis of these numbers, the NPV was 95.1%. Conclusions. Sonography has a high NPV and should be considered as a reasonable screening tool in the evaluation of acute appendicitis. Further imaging could be performed if clinical signs and symptoms worsen.     

Sonography of acute appendicitis in pregnancy

Background: Clinical evaluation of acute appendicitis is difficult in pregnant patients. Delay in diagnosis is associated with increased fetal mortality. The purpose of our study was to assess the value of sonography in the diagnosis of acute appendicitis in pregnant women. Methods: We obtained sonograms in 22 pregnant women suspected of acute appendicitis. All sonograms were performed using graded-compression to detect an enlarged appendix. The sonographic criteria for acute appendicitis were detection of a noncompressible blindended and tubular multilayered structure of maximal diameter greater than 6 mm. Results: The sonographic findings were correlated with surgical findings in seven cases and clinical follow-up in 15 cases. Acute appendicitis was diagnosed by sonography in three of 22 patients, and in all but one was confirmed by surgical and pathologic findings. In the remaining 19 patients, 15 improved on clinical follow-up; three were shown to have a normal appendix at surgery and one had focal acute inflammation at the tip of the appendix. Conclusions: Our experience suggests that graded-compression sonography is a useful procedure in pregnant patients suspected of acute appendicitis and has a similar accuracy as in nonpregnant women, especially in the first and second trimester.