Role of Ultrasonography in Acute Appendicitis of the Elderly. A Pictorial Essay

Acute appendicitis in the elderly represents an emerging problem. Although it has been considered for a long time an exclusive disease of the second and third decades of life, the increase of life expectancy has resulted in an increasing number of cases found in the elderly. While the key element for the diagnosis in the young is represented by typical history and symptoms, the diagnosis is more difficult in the elderly mostly due to atypical and paucysymtomatic presentation and high rate of complications. Therefore, the need of imaging techniques such as computed tomography to achieve a correct diagnosis is higher in the elderly than in the young patients, but the risk of nephrotoxicity using iodine contrast agents, the need to move the patient to the Radiology Department with consequent time delay and the difficulty in acquisition of the informed consent in urgent conditions are some of the main limits of this technique. In this context, ultrasound (US) represents a good imaging modality to achieve a correct and rapid diagnosis. Furthermore, the emerging role of contrastenhanced ultrasound has expanded the diagnostic scenarios in the assessment of this disease. In this short pictorial essay, we would like to report main US features of acute appendicitis in the elderly, highlighting the advantages of US assessment in comparison to other imaging techniques.