Figure 5.

A 19-year-old male presented with pain in the right upper quadrant of the abdomen of 1-day duration. Abdominal examination revealed tenderness and guarding in the right upper quadrant. The patient had no fever and no leukocytosis. The patient was suspected to have acute cholecystitis. Routine ultrasound was performed by a radiologist and reported as normal. Repeated point-of-care ultrasound 12 h later (a) using a high-frequency linear probe of the abdomen showed a noncompressible tubular structure in the subhepatic region having a target sign (arrow heads). Point-of-care ultrasound (b) using a small print convex array probe with a frequency of 3–5 MHz showed minimum amount of free fluid in the pelvis (yellow arrow). Laparoscopy confirmed the presence of subhepatic acute appendicitis. (Point-of-care ultrasound study was performed by Professor Fikri Abu-Zidan)