Purpose
Acute appendicitis is the most common abdominal surgical emergency.
The diagnosis or exclusion of appendicitis may be made clinically,
however clinical examination does not appear to be sufficiently reliable to always identify or exclude acute appendicitis .
Because of its speed and accuracy,
multislice CT has almost completely supplanted the traditional physical exam,
currently the vast majority of patients are exposed to substantial radiation when CTs are used as the first-line imaging choice.
However,
ultrasound can help the radiologist make a definitive diagnosis in most...
Methods and Materials
Color doppler sonography was performed to several patients,
referred for suspected appendicitis,
using a Phillips HD11 XE Ultrasound System.
First,
the entire abdomen was examined with a C5-2 Broadband Curved Array Transducer with 5 to 2 MHz extended operating frequency range,
75° Field of view,
steerable pulsed wave,
color Doppler,
High-PRF Doppler and Color Power Angio.
The evaluation of the right lower quadrant was performed mainly using an L12-3 Broadband Linear Array Transducer with 12 to 3 MHz extended frequency range,
35 mm effective aperture...
Results
More than 100 patients have been referred from the emergency department with a working diagnosis of acute appendicitis.
A total of 31 patients were found to be positive to acute appendicitis after the ultrasound scan.
From the patients with a negative or equivocal ultrasound,
4 were later diagnosed to have acute appendicitis.
Ultrasound was accurate enough for detecting appendicitis in most patients,
especialy those who had abdominal musculature with less fat content.
The opposite was true for CT scans,
where intraperitoneal fat actually improved the...
Conclusion
Any patient who presents to the emergency department with abdominal pain and is suspected to have appendicitis,
could benefit from sonographic imaging of their appendix.
Ultrasound was accurate enough to handle initial screening.
All patients with a positive ultrasound could be directed to surgery,
avoiding exposure to radiation.
Ultrasonography is a good "rule in" test to confirm appendicitis as its specificity rivals that of CT scanning.
Unfortunately,
its poor sensitivity in comparison to CT does not allow it to be utilized as a good "rule...
References
American College of Emergency Physicians,
Focus On: Ultrasound for Appendicitis,
June 1,
2012
Applied Radiology Journals,
Volume 31,
Number 3 ,
John P.
McGahan,
MD,
March 2002
Emergency Physicians Monthly,W.
Richard Bukata,
MD,
June 23,
2011
Cal J Emerg Med.
2007 May; 8(2): 41–45.
Personal Information
Dr.
Vasileios Moustakas
Radiology Department
Rhodes General Hospital
e-mail:
[email protected]