Sonography: First‐Line Modality in the Diagnosis of Acute Colonic Diverticulitis?

Helou, Nabil; Abdalkader, Mohamad; Abu‐Rustum, Reem S.

doi:10.7863/ultra.32.10.1689

Cited by 25 publications

(30 citation statements)

References 41 publications

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“…Considering the broad range of diverticular diseases, sonography is safe, widely available, easily accessible, portable, and affordable and has the advantage of allowing a rapid diagnosis in early uncomplicated diverticulitis because of its real-time dynamic information on bowel positioning and motility and the possibility of correlating sonographic findings with the point of tenderness. 5,7,8,21 Our analyses showed that in patients with suspected uncomplicated acute diverticulitis, the sensitivity (P= .81) and positive predictive value (P = .77) of CT versus sonography did not differ significantly. Our study supports previous literature, which reported comparable sensitivity and positive predictive values between CT and sonography for evaluating uncomplicated diverticulitis.…”

Section: Discussionmentioning

confidence: 67%

“…3,7,14,19,20 In cases in which abscesses are detected, CT can further guide percutaneous drainage and provide an indication for embolization of diverticular bleeding. However, CT is not readily available in emerging and underdeveloped nations, 21 requires increased time for interpretation by a radiologist, exposes the patient to ionizing radiation, and, unlike sonography, is not cost-effective. Considering the broad range of diverticular diseases, sonography is safe, widely available, easily accessible, portable, and affordable and has the advantage of allowing a rapid diagnosis in early uncomplicated diverticulitis because of its real-time dynamic information on bowel positioning and motility and the possibility of correlating sonographic findings with the point of tenderness.…”

Section: Discussionmentioning

confidence: 99%

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Benefits of Sonography in Diagnosing Suspected Uncomplicated Acute Diverticulitis

King

Shuaib

Vijayasarathi

et al. 2015

J of Ultrasound Medicine

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cute diverticulitis is one of the most common diseases in developed nations. The United States accounts for 10% of the cases in populations younger than 40 years and more than half of the population older than 65 years globally. 1,2 Although most cases resolve with conservative management, certain severe complications such as perforation, peritonitis, large abscesses, and fistulas can require urgent interventional or surgical management. Because of the ubiquity of computed tomography (CT) in the United States and the need for rapid diagnosis of complicated diverticulitis, CT has become the diagnostic modality of choice given its greater than 95% sensitivity, specificity, and positive and negative predictive values. 3,4 However, several studies have documented the Welfur C. King, MD, Waqas Shuaib, MD, Arvind Vijayasarathi, MD, Carlos G. Fajardo, MD, Waldo E. Cabrera, MD, Juan L. Costa, MD Received March 2, 2014, Objectives-Despite evidence demonstrating equivalent accuracy of sonography and computed tomography (CT) in the workup of mild/uncomplicated acute diverticulitis, CT is overwhelmingly performed as the initial diagnostic test, particularly in the acute setting. Our study evaluated potential radiation and turnaround time savings associated with performing sonography instead of CT as the initial diagnostic examination in the workup of suspected uncomplicated acute diverticulitis.Methods-We retrospectively reviewed medical records from January 2010 to December 2012 for patients presenting with clinical symptoms of acute diverticulitis. Patients were categorized as a whole and subgrouped by age (>40 and <40 years). A modified Hinchey classification (Am Surg 1999; 65:632-636) was used to stage the severity of the disease. The effective radiation dose was calculated by multiplying the dose length product from the scanner by the standard conversion coefficient (k = 0.0021 mSv/mGy × cm). The turnaround time for patients was calculated as the time the examination was ordered by the emergency department physician or staff to the time the report was finalized.Results-Our study included 253 patients (172 male and 81 female; mean age ± SD, 50.2 ± 11.7 years; 132 >40 years and 121 <40 years). The distribution of patients by the modified Hinchey classification was 210 (stages 0 and 1a), 26 (stages 1b and 2), 17 (stages 3 and 4), 0 (fistula), and 0 (obstruction). The estimated CT radiation dose per patient was 21 ± 5.2 mSv. Mean turnaround times for CT and sonography were 138.5 ± 76.9 and 51.3 ± 44 minutes, respectively.Conclusions-Sonography is a lower-cost, faster, and radiation-free alternative that measures up to the diagnostic standards of CT for management of suspected mild or uncomplicated acute diverticulitis.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Benefits of Sonography in Diagnosing Suspected Uncomplicated Acute Diverticulitis

King

Shuaib

Vijayasarathi

et al. 2015

J of Ultrasound Medicine

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“…Local wall thickening of the colon can also be seen with preservation of the sonographic layered appearance of bowel musculature. This can present as a non‐specific target sign . Inflamed surrounding mesentery and omentum appear hyperechoic and non‐compressible .…”

Section: Discussionmentioning

confidence: 99%

“…This can present as a non‐specific target sign . Inflamed surrounding mesentery and omentum appear hyperechoic and non‐compressible . Inspissated faeces or entrapped air, often causing shadow artefact, may be present within the out‐pouching bowel lumen .…”

Section: Discussionmentioning

confidence: 99%

“…Computed tomography (CT) suggested neoplasia before diverticulitis was confirmed via colonoscopy and biopsy. The distinctive sonographic features of diverticulitis are described including gut wall thickening, a rounded hypoechoic region extruding from bowel wall, adjacent echogenic inflammatory fat, shadowing caused by inspissated faeces and sonographically localised pain or tenderness . This case report presents a rare differential for acute RUQ pain mimicking cholecystitis.…”

Section: Introductionmentioning

confidence: 94%

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Acute right upper quadrant diverticulitis: an unusual sonographic finding in a young adult patient

2015

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Diagnostic accuracy of acute diverticulitis with unenhanced low-dose CT

et al. 2020

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Background: The aim of this study was to evaluate the diagnostic accuracy of unenhanced low-dose CT (LDCT) in acute colonic diverticulitis in comparison with contrast-enhanced standard-dose CT (SDCT). Methods: All patients with clinically suspected diverticulitis who underwent LDCT followed by SDCT between January and October 2017 were evaluated prospectively. CT examinations were assessed for signs of diverticulitis, complications and other differential diagnoses by three independent radiologists (two consultants and one fourth-year resident) using SDCT as the reference method. Sensitivity and specificity were calculated and Cohen's coefficient was used for agreement analyses. Results: Of the 149 patients included (mean age 66⋅7 years, M : F ratio 0⋅4), 107 (71⋅8 per cent) had imaging consistent with diverticulitis on standard CT. Sensitivity and specificity values for a diverticulitis diagnosis using LDCT were 95-99 and 86-100 per cent respectively, and respective values for identification of complications were 58-73 and 78-100 per cent. The corresponding values among the three readers for diagnosis were 0⋅984, 0⋅934 and 0⋅816, whereas values for complications were 0⋅680, 0⋅703 and 0⋅354. Of the 26 patients who presented with other causes of abdominal symptoms identified on standard CT, 23 were diagnosed correctly on LDCT. Missed cases included splenic infarction (1) and segmental colitis (2). Conclusion: The diagnostic accuracy of LDCT was high for the presence of acute diverticulitis. However, as signs of complicated disease can be missed using the low-dose protocol, use of LDCT as a primary examination method should not preclude SDCT when complications may be suspected.

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Sonography: First‐Line Modality in the Diagnosis of Acute Colonic Diverticulitis?

Cited by 25 publications

References 41 publications

Benefits of Sonography in Diagnosing Suspected Uncomplicated Acute Diverticulitis

Benefits of Sonography in Diagnosing Suspected Uncomplicated Acute Diverticulitis

Acute right upper quadrant diverticulitis: an unusual sonographic finding in a young adult patient

Diagnostic accuracy of acute diverticulitis with unenhanced low-dose CT

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