Sonography of Acute Right Lower Quadrant Pain: Importance of Increased Intraabdominal Fat Echo

Lee, Min Woo; Kim, Young Jun; Jeon, Hae Jeong; Park, Sang Woo; Jung, Sung Il; Yi, Jeong Geun

doi:10.2214/ajr.07.3330

Cited by 34 publications

(35 citation statements)

References 20 publications

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“…Another important limitation of sonography compared with CT has been its inability to stage the severity of inflammation. 16 This study showed that with the combination of ES and sonography, patients with acute appendicitis could be categorized into those with mild, moderate, and severe disease, and the findings correlated well with the surgical findings. A recent study by Lee et al 16 also tried to visualize the inflammatory changes in periappendiceal fat in acute appendicitis on sonography by detecting the changes in the echogenicity; however, we think that these can be better assessed on ES, as shown in this study.…”

Section: Discussionmentioning

confidence: 63%

“…16 This study showed that with the combination of ES and sonography, patients with acute appendicitis could be categorized into those with mild, moderate, and severe disease, and the findings correlated well with the surgical findings. A recent study by Lee et al 16 also tried to visualize the inflammatory changes in periappendiceal fat in acute appendicitis on sonography by detecting the changes in the echogenicity; however, we think that these can be better assessed on ES, as shown in this study. Moreover, with increasing literature on the medical management of acute appendicitis, 17 it would be worthwhile to use ES to triage such patients to decide on their surgical or medical approach.…”

Section: Discussionmentioning

confidence: 63%

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Real-time Elastography in Acute Appendicitis

Kapoor¹,

Mahajan²

2010

Journal of Ultrasound in Medicine

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 63%

Real-time Elastography in Acute Appendicitis

Kapoor¹,

Mahajan²

2010

Journal of Ultrasound in Medicine

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“…There is examination of the diagnostic qualities of some secondary signs: inflammatory fat changes (SN 91%, SP 76%), caecal wall thickening (SN 25%, SP 88%), lymph nodes (SN 32%, SP 62%) and peritoneal fluid (SN 51%, SP 71%). Lee et al 34 2009 Prospective study of 317 adult patients. Found that an increased intra-abdominal fat echo was seen in patients with appendicitis (SN 73%, SP 98%).…”

Section: Authormentioning

confidence: 99%

“…6). 34 The mesentery can provide both a path for disease spread and barrier for infection as it potentially walls off inflamed areas such as an acute appendix. A useful method for determining if there is an increase in mesenteric echogenicity is to compare the contralateral side of the patient as a baseline.…”

Section: Secondary Sonographic Signsmentioning

confidence: 99%

“…Secondary signs of appendicitis are well established with a recent investigation of their predictive value identifying potential diagnostic use in the absence of an identifiable appendix. 3,34,35 The purpose of this review is to examine appendiceal sonography, established sonographic criteria, paediatric-specific techniques and the predictive value of secondary signs.…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound of paediatric appendicitis and its secondary sonographic signs: providing a more meaningful finding

Reddan

Corness

Mengersen

et al. 2016

J of Medical Radiation Sci

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Sonography is an important clinical tool in diagnosing appendicitis in children as it can obviate both exposure to potentially harmful ionising radiation from computed tomography scans and the need for unnecessary appendicectomies. This review examines the diagnostic accuracy of ultrasound in the identification of acute appendicitis, with a particular focus on the the utility of secondary sonographic signs as an adjunct or corollary to traditionally examined criteria. These secondary signs can be important in cases where the appendix cannot be identified with ultrasound and a more meaningful finding may be made by incorporating the presence or absence of secondary sonographic signs. There is evidence that integrating these secondary signs into the final ultrasound diagnosis can improve the utility of ultrasound in cases where appendicitis is expected, though there remains some conjecture about whether they play a more important role in negative or positive prediction in the absence of an identifiable appendix.

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Paediatric appendiceal ultrasound: a survey of Australasian sonographers’ opinions on examination performance and sonographic criteria

Reddan

Corness

Harden

et al. 2018

J of Medical Radiation Sci

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IntroductionThe objectives of this study were to identify knowledge gaps and/or perceived limitations in the performance of paediatric appendiceal ultrasound by Australasian sonographers. We hypothesised that: sonographers’ confidence in visualising the appendix in children was poor, particularly outside predominantly paediatric practice; workplace support for prolonging examinations to improve visualisation was limited; and the sonographic criteria applied in diagnosis did not reflect contemporary literature.MethodsA cross‐sectional survey of Australasian sonographers regarding paediatric appendicitis was conducted using a mixed methods approach (quantitative and qualitative data). Text responses were analysed for key themes, and quantitative data analysed using chi‐square, Mann–Whitney U and Wilcoxon signed‐rank tests.ResultsOf the 124 respondents, 27 (21.8%) reported a visualisation rate of less than 10%. Workplace support for extending examination time was significantly related to a higher appendix visualisation rate (χ 2(2) = 16.839, P < 0.001). Text responses reported frustration locating the appendix and a desire for more time and practice to improve visualisation. Sonographers suggested a significantly lower maximum diameter cut‐off in a 5‐year‐old compared to a 13‐year‐old (Z = −6.07, P < 0.001), and considered the presence of inflamed peri‐appendiceal mesentery as the most useful sonographic criterion in diagnosing acute appendicitis.ConclusionsRespondents had a low opinion of their ability to confidently identify the appendix. Confidence was greater in those centres where extending scanning time was encouraged. Application of echogenic mesentery as the most significant secondary sonographic criterion is supported by recent studies. Opinions of diameter cut‐offs varied, indicating potential for improved awareness of recent research.

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Sonography of Acute Right Lower Quadrant Pain: Importance of Increased Intraabdominal Fat Echo

Abstract: An increased intraabdominal fat echo on sonography is highly specific for the presence of RLQ inflammatory disease.

Cited by 34 publications

References 20 publications

Real-time Elastography in Acute Appendicitis

Real-time Elastography in Acute Appendicitis

Ultrasound of paediatric appendicitis and its secondary sonographic signs: providing a more meaningful finding

Paediatric appendiceal ultrasound: a survey of Australasian sonographers’ opinions on examination performance and sonographic criteria

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