Imaging of acute right lower quadrant abdominal pain: differential diagnoses beyond appendicitis

Heller, Matthew T.; Hattoum, Alexander

doi:10.1007/s10140-011-0997-9

Cited by 19 publications

(13 citation statements)

References 33 publications

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“…However, there is as yet no consensus whether WBC and/or CRP can support the clinical diagnosis of appendicitis . Therefore, imaging has evolved to play a pivotal role in the diagnosis of AA . Our study reported a significant difference in plasma CP and SAA‐1 levels between patients with AA and other abdominal complaints (and a healthy control group).…”

Section: Discussionmentioning

confidence: 62%

Evaluation of the Diagnostic Accuracy of Plasma Markers for Early Diagnosis in Patients Suspected for Acute Appendicitis

Schellekens

Hulsewé

Acker³

et al. 2013

Acad Emerg Med

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Objectives: The main objective of this study was to evaluate the diagnostic accuracy of two novel biomarkers, calprotectin (CP) and serum amyloid A (SAA), along with the more traditional inflammatory markers C-reactive protein (CRP) and white blood cell count (WBC), in patients suspected of having acute appendicitis (AA). The secondary objective was to compare diagnostic accuracy of these biomarkers with a clinical scoring system and radiologic imaging.Methods: A total of 233 patients with suspected AA, presenting to the emergency department (ED) between January 2010 and September 2010, and 52 healthy individuals serving as controls, were included in the study. Blood was drawn and CP and SAAÀ1 concentrations were measured using enzyme-linked immunosorbent assay (ELISA). CRP and WBC concentrations were routinely measured and retrospectively abstracted from the electronic health record, together with physical examination findings and radiologic reports. The Alvarado score was calculated as a clinical scoring system for AA. Final diagnosis of AA was based on histopathologic examination. The Mann-Whitney U-test was used for between-group comparisons. Receiver operating characteristic (ROC) curves were used to measure the diagnostic accuracy for the tests and to determine the best cutoff points.Results: Seventy-seven of 233 patients (33%) had proven AA. Median plasma levels for CP and SAAÀ1 were significantly higher in patients with AA than in those with another final diagnosis (CP, 320.9 ng/mL vs. 212.9 ng/mL; SAAÀ1, 30 mg/mL vs. 0.6 mg/mL; p < 0.001). CRP and WBC were significantly higher in patients with AA as well. The Alvarado score was helpful at the extremes (<3 or >7). Ultrasound (US) had a sensitivity of 84% and a specificity of 94%. Computed tomography (CT) had a sensitivity of 100% and a specificity of 91%. The area under the ROC (95% confidence interval [CI]) was 0.67 (95% CI = 0.60 to 0.74) for CP, 0.76 (95% CI = 0.70 to 0.82) for SAA, 0.71 (95% CI = 0.64 to 0.78) for CRP, and 0.79 (95% CI = 0.73 to 0.85) for WBC. No cutoff points had high enough sensitivity and specificity to accurately diagnose AA. However, a high sensitivity of 97% was shown at 7.5 9 10 9 /L for WBC and 0.375 mg/mL for SAA.Conclusions: CP, SAAÀ1, CRP, and WBC were significantly elevated in patients with AA. None had cutoff points that could accurately discriminate between AA and other pathology in patients with suspected AA. A WBC < 7.5 9 10 9 /L, with a low level of clinical suspicion for AA, can identify a subgroup of patients who may be sent home without further evaluation, but who should have available next-day follow-up.ACADEMIC EMERGENCY MEDICINE 2013; 20:703-710

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Section: Discussionmentioning

confidence: 62%

Evaluation of the Diagnostic Accuracy of Plasma Markers for Early Diagnosis in Patients Suspected for Acute Appendicitis

Schellekens

Hulsewé

Acker³

et al. 2013

Acad Emerg Med

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“…Computed tomography is the imaging modality of choice, by which one can recognize any of the four abovementioned patterns of appendicular diverticular disease. The recommended protocol in patients with right lower quadrant pain comprises contrast-enhanced multi-detector CT of the abdomen obtained in the portal venous phase with or without rectal contrast [1]. In English literature, only very few case reports, where a definite preoperative diagnosis of appendiceal diverticulitis, were made [10][11][12].…”

Section: Discussionmentioning

confidence: 99%

“…The most common pathology in patients with right lower quadrant pain is appendicitis [1]. Although uncommon, appendiceal diverticula are encountered in up to 2 % of appendectomy specimens [2].…”

Section: Introductionmentioning

confidence: 99%

Diverticulitis of the appendix, a distinctive entity: preoperative diagnosis by computed tomography

et al. 2015

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Diverticular disease of the appendix is rare and is usually diagnosed during surgery. We report a case of a 50-year-old man who presented to the emergency department with right lower quadrant pain of 1-day duration. A preoperative diagnosis of appendiceal diverticulitis was made by computed tomography of the abdomen. The patient underwent emergency laparoscopic appendectomy, which confirmed the diagnosis.

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“…However, other inflammatory (appendiceal diverticulitis, inflammatory bowel disease) and non-inflammatory (eg, neoplasia) conditions can also affect the appendix 1. Differentiating infection from other conditions that might affect the appendix can sometimes be difficult radiologically,2 leading to a diagnostic challenge.…”

Section: Introductionmentioning

confidence: 99%

Chronic inflammation masquerading as an appendiceal tumour with peritoneal metastasis: the challenge of diagnosis and the lessons learnt

Almerie¹,

Culverwell

Krishna

et al. 2016

BMJ Case Reports

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Advanced radiological imaging has largely replaced exploratory operations and has become an essential diagnostic tool clinicians routinely rely on. However, physicians are faced with a lot of radiological findings without histological proof, and assuming a more serious diagnosis may lead to unnecessary investigations and emotional stress for patients. We report an unusual presentation of chronic appendicitis with a synchronous peritoneal nodule on CT in a 76-year-old woman who presented with poor appetite, weight loss and a mass in the right iliac fossa. The coincidental finding of the nodule in addition to the suspicious appearance of the appendix raised concerns for primary appendiceal cancer with peritoneal metastasis. The case illustrates the patient's management and reflects on the learnt lessons with regard to careful use of invasive radiology-guided biopsies and interval imaging, as these could sometimes delay the diagnosis and management of a readily treatable disease.

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Imaging of acute right lower quadrant abdominal pain: differential diagnoses beyond appendicitis

Cited by 19 publications

References 33 publications

Evaluation of the Diagnostic Accuracy of Plasma Markers for Early Diagnosis in Patients Suspected for Acute Appendicitis

Evaluation of the Diagnostic Accuracy of Plasma Markers for Early Diagnosis in Patients Suspected for Acute Appendicitis

Diverticulitis of the appendix, a distinctive entity: preoperative diagnosis by computed tomography

Chronic inflammation masquerading as an appendiceal tumour with peritoneal metastasis: the challenge of diagnosis and the lessons learnt

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