Keywords:
Infection, Acute, Diagnostic procedure, Audit and standards, Ultrasound, CT, Emergency, Abdomen
Authors:
P. Sousa1, A. Ferreira2, L. Gargaté1; 1Loures/PT, 2Lisboa, Grande Lisboa/PT
DOI:
10.26044/ecr2019/C-0583
Methods and materials
This is a retrospective analysis of consecutive patients who underwent appendectomy with suspected acute appendicitis between January 2017 and August 2018.
Patient’s demographics,
clinical,
histopathology and preoperative radiology reports were reviewed.
The normal appendix is a blind-ended tubular structure,
originating from the base of the cecum, non-peristaltic,
tubular structure with wall thickness <3 mm,
outer diameter <6 mm and is compressible.
In our institution diagnosis of acute appendicitis is made in the appropriate clinical scenario,
using standard graded compression technique on the visualisation of a non-compressible,
≥6 mm in maximum diameter,
with increased wall thickness,
occasionally with an appendicolith.
Indirect signs of a regional inflammatory process like free fluid,
hyperechogenicity of the fat,
enlarged lymph nodes are all important to support diagnosis - Figure 1.
Ultrasound reports were reviewed and classified as “positive” (committal report by the radiologist),
inconclusive” (worrisome findings,
but a non-committal report by the radiologist) or “negative” (acute appendicitis dismissed by the radiologist) and confronted with histological results.
A negative appendectomy was defined as a histologically normal appendix at time of removal.
Descriptive statistics,
ultrasound sensitivity,
positive predictive value (PPV) and Negative Appendectomy Rate (NAR) were calculated.