Sonography of Acute Appendicitis in a 9-Month-Old Infant Eugenia Cherniavsky, MD, Pavel Crystal, MD, Yehiel Barki, MD cute appendicitis is a rare and potentially fatal disease in infants, and early diagnosis remains a most challenging aspect. 1,2 Clinical diagnosis can be elusive. In this report, we describe sonographic findings of acute appen- dicitis in a 9-month-old male infant. We are unaware of other reports of preoperative sonographic diagnosis of acute appendicitis at such an early age. Received December 30, 2003, from the Department of Radiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel. Revision requested January 2, 2004. Revised manuscript accepted for publication January 21, 2004. Address correspondence and reprint requests to Pavel Crystal, MD, Department of Radiology, Soroka University Medical Center, PO Box 151, Beer-Sheva 84105, Israel. E-mail: pcrystal@bgumail.bgu.ac.il. Abbreviations WBC, white blood cell Case Report A 9-month-old male infant was brought to the pediatric emergency department with vomiting, fever, irritability, and abdominal distension. The white blood cell (WBC) count at admission was 7500 cells/mm 3 . Other laborato- ry tests were unremarkable. The infant was transferred to the pediatric ward for observation with presumed diag- nosis of gastroenteritis. After 2 days of observation, a precise clinical diagnosis was not achieved. Meanwhile, the patient’s condition deteriorated clinically, abdomi- nal tenderness increased, and the WBC count rose to 16,400 cells/mm 3 . Abdominal sonography was ordered for further evaluation. The scan was performed on an HDI 5000 system (Philips Medical Systems, Bothell, WA) with a broadband 5- to 12-MHz linear array transducer. A routine graded compression technique through the ante- rior abdominal wall did not reveal any abnormality. Subsequently, the transducer was applied to the right flank from the posterior aspect without using compres- sion, and a retrocecal appendix was identified as a tubu- lar, blind-ended structure, measuring 7 mm in maximal cross-sectional diameter (Figure 1). The sonographic diagnosis of acute appendicitis was confirmed surgically. At laparotomy, a retrocecal perfo- rated appendix was visualized directly under the liver, and an appendectomy was performed. After an unevent- ful postoperative period, the patient was discharged 9 days after surgery. © 2004 by the American Institute of Ultrasound in Medicine • J Ultrasound Med 2004; 23:865–867 • 0278-4297/04/$3.50 A Case Report