Clinical Awareness and Acceptance of Sonographically Diagnosed Epiploic Appendagitis (EA): A Retrospective Analysis of EA in a Single Tertiary Academic Referral Center

Abstract

Purpose To describe the clinical awareness and acceptance of ultrasound-diagnosed acute epiploic appendagitis (EA) and their importance to avoid unnecessary therapeutic and imaging measures. Patients and Methods The data were obtained of n=54 patients with acute, localized, peritonitic pain and EA diagnosed by B-mode ultrasound and contrast-enhanced ultrasound examination from November 2003 to September 2020. All examinations were performed by a German Society for Ultrasound in Medicine (DEGUM) Level III qualified examiner. Based on documentation by the treating physicians, the clinical awareness and acceptance of EA diagnosis was determined in all patients and compared between subgroups diagnosed before 2013 and from 2013 onwards. In 2013, a local educational training program regarding the diagnosis of and therapy for EA was initiated for physicians. Results In all patients, EA was sonographically diagnosed by a DEGUM level III qualified examiner. At enrollment, EA was mentioned as a suspected clinical diagnosis in n=1/54 (1.9%) patient. Furthermore, in n=39/54 (72.2%) cases, the EA was documented and accepted by the treating physicians at the time of patient discharge as the final clinical diagnosis. The clinical acceptance was significantly higher from 2013 onwards compared with before 2013 (p<0.05). Moreover, in n=26/54 (48.1%) patients, unnecessary therapeutic measures were initiated, with no significant difference between pre-2013 and post-2013 numbers (p>0.05). Conclusion In our retrospective study, we showed that awareness and acceptance of the disease EA are low. Low diagnostic acceptance of EA by the clinician leads to unnecessary therapeutic and imaging measures and is a general problem related to rare diseases in the healthcare system.

The Value of Contrast-Enhanced Ultrasound (CEUS) in the Detection of Perfusion Disturbances in Abdominal Wall Hernias Compared with Surgical and Histological Assessment

“…The high sensitivity and specificity of CEUS in the diagnosis of perfusion disturbance in incarcerated hernias demonstrate that CEUS should be considered a useful and cost-effective method without a radiation-exposing imaging modality. The findings of this study are in accordance with previous studies that showed that CEUS has a high diagnostic performance in the detection of perfusion disturbance [ 8 , 9 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. Notably, the cause of NEAs in CEUS was an omental tissue fibrosis in four cases.…”

“…A widely used and proven imaging modality in clinical practice for the detection of perfusion disturbances is contrast-enhanced ultrasound (CEUS) [ 8 , 9 , 10 , 11 , 12 ].…”

Diagnostic performance of point of care ultrasonography for acute epiploic appendagitis in the emergency department

“…In the management of patients with painful acute abdomen, computed tomography (CT) is accepted as extremely sensitive in the characterization of abdominal surgical pathologies but can cause adverse effects due to high ionizing radiation exposure and intravenous injection of contrast material. While CT reveals the diagnostic findings for EA, which is currently treated conservatively, it is also effective in discounting other intra-abdominal pathologies [5]. However, due to insufficient awareness and the probable reporting of EA cases at much lower rates than there are in reality, up to 64% are overlooked, including in CT reports [5].…”

“…While CT reveals the diagnostic findings for EA, which is currently treated conservatively, it is also effective in discounting other intra-abdominal pathologies [5]. However, due to insufficient awareness and the probable reporting of EA cases at much lower rates than there are in reality, up to 64% are overlooked, including in CT reports [5]. Nevertheless, it has been reported by centers experienced in gastrointestinal imaging that ultrasonography (US) could be a reserve diagnostic method before CT examination or in the presence of CT findings that are suspicious in respect of EA [6].…”

Diagnostic Performance of Point Shear Wave Elastography (pSWE) Using Acoustic Radiation Force Impulse (ARFI) Technology in Mesenteric Masses: A Feasibility Study

“…In addition, magnetic resonance imaging (MRI), positron emission tomography–computed tomography (PET-CT), and B-mode ultrasound (US) are used for evaluating MMs [ 2 , 3 , 9 , 10 ]. As a new trend in US imaging, contrast-enhanced ultrasound (CEUS) is used to assess perfusion patterns of various pathologies, including MMs [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. Another new trend in US imaging is US elastography, which is a non-invasive tool for assessing tissue stiffness, with guidelines available for hepatic and non-hepatic applications [ 21 , 22 , 23 , 24 , 25 , 26 ].…”