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How to diagnose acute appendicitis: ultrasound first
#MMPMID26883138
Mostbeck G
; Adam EJ
; Nielsen MB
; Claudon M
; Clevert D
; Nicolau C
; Nyhsen C
; Owens CM
Insights Imaging
2016[Apr]; 7
(2
): 255-63
PMID26883138
show ga
Acute appendicitis (AA) is a common abdominal emergency with a lifetime
prevalence of about 7 %. As the clinical diagnosis of AA remains a challenge to
emergency physicians and surgeons, imaging modalities have gained major
importance in the diagnostic work-up of patients with suspected AA in order to
keep both the negative appendectomy rate and the perforation rate low. Introduced
in 1986, graded-compression ultrasound (US) has well-established direct and
indirect signs for diagnosing AA. In our opinion, US should be the first-line
imaging modality, as graded-compression US has excellent specificity both in the
paediatric and adult patient populations. As US sensitivity is limited, and
non-diagnostic US examinations with non-visualization of the appendix are more a
rule than an exception, diagnostic strategies and algorithms after non-diagnostic
US should focus on clinical reassessment and complementary imaging with MRI/CT if
indicated. Accordingly, both ionizing radiation to our patients and cost of
pre-therapeutic diagnosis of AA will be low, with low negative appendectomy and
perforation rates. Main Messages ? Ultrasound (US) should be the first imaging
modality for diagnosing acute appendicitis (AA). ? Primary US for AA diagnosis
will decrease ionizing radiation and cost. ? Sensitivity of US to diagnose AA is
lower than of CT/MRI. ? Non-visualization of the appendix should lead to clinical
reassessment. ? Complementary MRI or CT may be performed if diagnosis remains
unclear.
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