Accuracy of Ultrasound in the Diagnosis of Acute Appendicitis Compared With the Surgeon's Clinical Impression

Wade, David S.; Morrow, Stephen E.; Balsara, Z N; Burkhard, T K; Goff, Walter B.

doi:10.1001/archsurg.1993.01420210103014

Cited by 99 publications

(66 citation statements)

References 21 publications

(3 reference statements)

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“…Computed tomography of the abdomen and pelvis (CT-A/P) has become the diagnostic modality of choice for evaluation of acute right lower quadrant abdominal pain [1][2][3]. CT-A/P has become an important diagnostic tool to diagnose or exclude acute appendicitis, with a sensitivity and negative predictive value that surpasses compression sonography and clinical exam [4][5][6][7]. The rates of negative appendectomies have decreased from up to 20% to as low as 1.7% when using preoperative CT scans [8,9].…”

Section: Introductionmentioning

confidence: 99%

Handheld Device Review of Abdominal CT for the Evaluation of Acute Appendicitis

Choudhri

Carr

et al. 2011

J Digit Imaging

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Advances in handheld computing now allow review of DICOM datasets from remote locations. As the diagnostic ability of this tool is unproven, we evaluated the ability to diagnose acute appendicitis on abdominal CT using a mobile DICOM viewer. This HIPAA compliant study was IRB-approved. Twenty-five abdominal CT studies from patients with RLQ pain were interpreted on a handheld device (iPhone) using a DICOM viewer (OsiriX mobile) by five radiologists. All patients had surgical confirmation of acute appendicitis or follow-up confirming no acute appendicitis. Studies were evaluated for the ability to find the appendix, maximum appendiceal diameter, presence of an appendicolith, periappendiceal stranding and fluid, abscess, and an assessment of the diagnosis of acute appendicitis. Results were compared to PACS workstation. Fifteen cases of acute appendicitis were correctly identified on 98% of interpretations, with no false-positives. Eight appendicoliths were correctly identified on 88% of interpretations. Three abscesses were correctly identified by all readers. Handheld device measurement of appendiceal diameter had a mean 8.6% larger than PACS measurements (p=0.035). Evaluation for acute appendicitis on abdominal CT studies using a portable device DICOM viewer can be performed with good concordance to reads performed on PACS workstations.

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Section: Introductionmentioning

confidence: 99%

Handheld Device Review of Abdominal CT for the Evaluation of Acute Appendicitis

Choudhri

Carr

et al. 2011

J Digit Imaging

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“…Wade et al [10] reported that 24% of patients had ultrasound study that was considered normal. Ahalli [11] in a study in Morocco showed that ultrasound Clinical or clinical and laboratory scoring systems have been proposed to predict the diagnosis and the patient's prognosis.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of Acute Appendicitis in Sub-Saharan Africa

Ouedraogo¹,

Ouédraogo²,

Kambou³

et al. 2018

OJMI

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Objective: The aim of our study was to propose a solution for rationalizing requests for ultrasound examination and CT scan in suspected acute appendicitis, based on use of the Alvarado score. Patients and Methods: We included in our study all patients consulting for pain of the right iliac fossa, whatever their age and sex, who had been diagnosed with acute appendicitis and who had undergone appendectomy. We used the Alvarado scoring system, based on clinical items and laboratory measurements, to diagnose appendicitis. Results: One hundred eleven patients, of whom 77 were men (69.4%) and 34 were women (30.6%), with a sex ratio of 2:2.6, were included. Mean age was 31.29 ± 1.31 years, with a range of 1 to 81 years. The diagnosis of definite appendicitis was established in 54 patients (48.6%). Abdominal ultrasound examination had been performed in 80 patients (72.1%). It established a diagnosis of appendicitis in 69 patients (86.2%), while in 11 patients (13.8%) the appendix was described as normal or was not visualized. Conclusion: Our study demonstrated good agreement between preoperative diagnosis and the result of the Alvarado score applied a posteriori. Ultrasound was not always contributory to the diagnosis of acute appendicitis. It could be reserved for patients whose clinical and laboratory score indicated that appendicitis was unlikely.

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“…A utilização da técnica de compressão gradual e o uso de transdutores de alta freqüência e excelente resolução espacial são fundamentais para o diagnóstico correto. Tem sido observado que a sensibilidade, especificidade, valor preditivo positivo e negativo e a acurácia da ultra-sonografia para o diagnóstico de um processo apendicular podem ser superiores à avaliação clínica realizada pelo cirurgião 13 . Este tipo de estudo pode reduzir o número de laparotomias brancas em até 20,0% [14][15][16] .…”

Section: Discussionunclassified

“…Embora testes laboratoriais únicos tenham validade limitada, um valor preditivo negativo de 100% tem sido registrado em testes triplos de combinação 9,13 .…”

Section: Discussionunclassified

Avaliação ultra-sonográfica da apendicite aguda

Torres

Lins

Nunes

et al. 2001

Rev. Col. Bras. Cir.

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RESUMO: Objetivo:A apendicite aguda é a mais comum urgência cirúrgica abdominal. Na tentativa de aumentar a acurácia diagnóstica a ultra-sonografia abdominal tem sido observada como método sensível e específico. O presente estudo tem por objetivo avaliar a ultra-sonografia do abdome no diagnóstico de apendicite aguda. Méto-do: Um total de 138 pacientes submetidos a tratamento cirúrgico com suspeita diagnóstica admitidos no Hospital Municipal Djalma Marques foi estudado no período de janeiro de 1997 a dezembro de 1998. Todos os exames foram realizados na mesma instituição e havia 87 pacientes do sexo masculino (63,0%) e 51 do sexo feminino (37,0%) com idade variando de 11 a 81 anos (média de 28,4 anos). Resultados: Dos 134 casos com diagnóstico comprovado cirurgicamente, o estudo ultra-sonográfico foi positivo em 114 (sensibilidade de 85,0%). O apêndice foi visualizado como imagem longitudinal ou transversal maior do que 7mm em 75 dos 114 achados positivos (65,8%). Conclusões: Os autores concluem que a ultra-sonografia abdominal é um instrumento valioso no diagnóstico de apendicite aguda.Descritores: Apendicite aguda; Ultra-sonografia abdominal; Diagnóstico ultra-sonográfico.Revista do Colégio Brasileiro de Cirurgiões -Vol. 28 -n o 1 -39 INTRODUÇÃOA apendicite aguda é a mais comum urgência cirúr-gica abdominal não traumática. O diagnóstico é geralmente baseado nos sintomas clínicos, principalmente com dor na fossa ilíaca direita, náuseas, vômitos, anorexia e febre, e no resultado do exame físico e de exames laboratoriais simples. Os achados mais comuns são dor à descompressão na fossa ilíaca direita, leucocitose com neutrofilia e desvio à esquerda 1-3 . Entretanto, os achados clínicos e laboratoriais podem ser inespecíficos o que contribui para taxas de 15% a 47% de laparotomias brancas em pacientes com diagnóstico de apendicite aguda. Por outro lado, a freqüência de apêndice perfurado varia de 20% a 30%, em geral determinada pelo retardo no tratamento cirúrgi-co 2,4 . O diagnóstico precoce possibilita a intervenção antes que surjam complicações, como peritonite generalizada e sepse. Na tentativa de aumentar a acurácia diagnóstica e diminuir o número de complicações alguns outros métodos de diagnóstico têm sido utilizados. A radiografia simples do abdome tem valor limitado, demonstrando anormalidades em menos de 50% dos exames e é muito inespecífica 2,4-6 .Alguns estudos têm mostrado que a ultra-sonografia abdominal é sensível e específica, aumentando a acurácia diagnóstica e reduzindo a possibilidade de regressão da doença através de um diagnóstico mais precoce e conse-

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Accuracy of Ultrasound in the Diagnosis of Acute Appendicitis Compared With the Surgeon's Clinical Impression

Cited by 99 publications

References 21 publications

Handheld Device Review of Abdominal CT for the Evaluation of Acute Appendicitis

Handheld Device Review of Abdominal CT for the Evaluation of Acute Appendicitis

Diagnosis of Acute Appendicitis in Sub-Saharan Africa

Avaliação ultra-sonográfica da apendicite aguda

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