Diagnosing Acute Appendicitis in Adults: Accuracy of Color Doppler Sonography and MDCT Compared with Surgery and Clinical Follow-Up

Gaitini, Diana; Beck-Razi, Nira; Mor-Yosef, David; Fischer, Doron; Itzhak, Ofer Ben; Krausz, Michael M.; Engel, Ahuva

doi:10.2214/ajr.07.2955

Cited by 121 publications

(114 citation statements)

References 29 publications

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“…Several published studies have compared the diagnostic accuracy of sonography and CT and have proposed sonography as a primary diagnostic tool, followed by CT only in select cases. 17,18 Although those studies differed somewhat from our study in that they did not perform CT when a definite diagnosis was obtained with sonography, our study also supports a similar conclusion. In another study that prospectively compared the accuracy of sonography versus CT for detecting appendicitis in patients with acute abdominal pain, CT showed higher sensitivity compared to sonography, but there was no significant difference in the predictive values of CT and sonography.…”

Section: Diagnosis On Both Sonography and Ct Final Diagnosissupporting

confidence: 78%

Does Computed Tomography Have Any Additional Value After Sonography in Patients With Suspected Acute Appendicitis?

Koo

Kim

Yang

et al. 2013

J of Ultrasound Medicine

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cute appendicitis is the most common condition requiring prompt abdominal surgery to minimize morbidity and mortality. Sonography and computed tomography (CT) have been widely used as the preferred imaging tools in patients with suspected acute appendicitis. 1 In previous studies of these diagnostic techniques, the sensitivities and specificities of sonography were 67% to 88% and 78% to 100%, respectively, whereas the sensitivities and specificities of CT were 76% to 96% and 75% to 95%. [2][3][4][5][6] Hye Soo Koo, MD, Hyun Cheol Kim, MD, Dal Mo Yang, MD, Sang Won Kim, MD, Seong Jin Park, MD, Jung Kyu Ryu, MD Received December 17, 2012, Objectives-The purpose of this study was to evaluate the additional value of supplementary computed tomography (CT) after sonography for diagnosing acute appendicitis.Methods-Among 140 consecutive patients with suspected acute appendicitis who underwent both initial sonography and supplementary CT within 12 hours, 88 patients whose appendices could not be visualized on sonography were excluded. The remaining 52 patients (mean age, 37.3 years; range, 15-98 years) were enrolled in this study. Two radiologists retrospectively reviewed the findings of 52 sonographic and CT examinations, and the appendix of each patient was classified as normal, equivocal appendicitis, nonperforated acute appendicitis, or perforated appendicitis. Causes of right lower quadrant pain other than appendicitis were also recorded. The additional value of supplementary CT was evaluated by performing head-to-head comparisons between CT and sonographic results.Results-No patients with a normal appendix on sonography showed appendicitis on CT. In addition, there were no patients with a sonographic diagnosis of appendicitis who had a normal appendix on CT. Ten patients (19.2%) were determined to have additional value gained from CT. Among these 10 patients, however, the additional information from CT affected treatment modality decisions in only 5.Conclusions-Initial sonography can be as effective as CT in patients with suspected acute appendicitis when the results are definite. Supplementary CT should only be performed when sonography is inconclusive.

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Section: Diagnosis On Both Sonography and Ct Final Diagnosissupporting

confidence: 78%

Does Computed Tomography Have Any Additional Value After Sonography in Patients With Suspected Acute Appendicitis?

Koo

Kim

Yang

et al. 2013

J of Ultrasound Medicine

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“…They recommended using CT examination only to confirm diagnoses in cases in which USG was not sufficient. [11] Gutierrez et al investigated the correlation between USG and Doppler in diagnosing acute appendicitis and found a sensitivity of 90% and a specificity of 94%. They attempted to improve the diagnostic accuracy of USG for acute appendicitis by adding Doppler imaging.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of Appendicular Doppler USG in Acute Appendicitis

Uzunosmanoğlu¹

2016

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Acute appendicitis is one of the most common causes of acute abdominal pain prompting emergency department (ED) visits. It is critical for the physicians to promptly and accurately diagnose acute appendicitis. The present study aimed to evaluate the diagnostic efficacy of Doppler ultrasonography (USG) in patients with acute appendicitis and compare this new method with other commonly used radio-diagnostic tools.

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“…CT scan is best reserved as a second line imaging modality when ultrasonography findings are negative or equivocal in a case with strong clinical suspicion. [8][9][10] Advantages of ultrasonography are that it can be carried out with minimum delay and can yield surgically relevant information like confirmation of diagnosis of appendicitis, status of inflamed appendix, location and orientation of appendix, presence or absence of any associated complications, etc. besides suggesting alternative diagnoses, which helps in appropriate surgical planning.…”

Section: Case Reportmentioning

confidence: 99%

Endometriosis with salpingitis simulating acute appendicitis

Debnath

Kumar

Gupta

et al. 2011

Medical Journal Armed Forces India

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(5 MHz, 6 MHz convex and linear probes; Wipro GE LOGIQ P3) with a partially distended urinary bladder revealed bilateral complex adnexal masses with internal echoes ( Figure 1A, B) abutting the uterus. The uterus, however, was found to be normal. The ovaries could not be demonstrated separately. Free fluid was present in RIF as well as pouch of Douglas. Using graded compression, a blind ending, tubular, non-compressible and non-peristaltic structure (diameter: 7 mm) was found extending from the RIF towards the midline (Figure 2). There was probe tenderness over this tubular structure. Although, the images of the tubular structure as mentioned above were not typical for classical appendicitis, based on the clinical profile and ultrasonographic findings, possibility of atypical appendicitis in association with pelvic endometriosis was raised. The attending surgical specialist was informed about pros and cons of the ultrasonographic findings who decided in favour of surgery. At surgery, the appendix was found to be normal. Appendectomy was carried out. The incision line was extended to look for pelvic pathologies. There were bilateral endometriotic ovarian cysts (chocolate cysts) with the right ovarian cyst having been ruptured with spillage of chocolate coloured fluid contents in the pelvis and RIF. Both ovarian cysts were plastered with the uterus with extensive adhesions in the pelvis and nearby areas (grade IV endometriosis). What was thought to be an atypical appendicitis on USG was actually an inflamed and kinked right fallopian tube extending from the right iliac fossa reaching almost up to the midline with the ampullary end directed medially. There were multiple areas of endometrial implants on the fallopian tube. Opinion of gynaecologist was sought during the surgery who advised medical treatment for endometriosis. The patient has been put on tab danazol 100 mg BD and has shown good response on follow up after two months. DISCUSSIONAcute appendicitis remains the most common surgical emergency with a life-time occurrence of 7%. Despite being a common problem and technological advancement in the recent past, acute appendicitis may still pose a diagnostic dilemma even to the best of clinicians. Laboratory investigations, though useful, are often non-specific. There are a sizeable number of conditions which can mimic appendicitis, some of them are urolithiasis, pelvic inflammatory disease, pyelonephritis, haemorrhagic ovarian cyst, ovarian torsion,

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Diagnosing Acute Appendicitis in Adults: Accuracy of Color Doppler Sonography and MDCT Compared with Surgery and Clinical Follow-Up

Abstract: Sonography should be the first imaging technique in adult patients for the diagnosis of acute appendicitis and triage of acute abdominal pain. CT should be used as a complementary study for selected cases.

Cited by 121 publications

References 29 publications

Does Computed Tomography Have Any Additional Value After Sonography in Patients With Suspected Acute Appendicitis?

Does Computed Tomography Have Any Additional Value After Sonography in Patients With Suspected Acute Appendicitis?

Diagnostic Value of Appendicular Doppler USG in Acute Appendicitis

Endometriosis with salpingitis simulating acute appendicitis

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