What is the complementary role of ultrasound evaluation in the diagnosis of acute appendicitis after CT?
Introduction
Appendicitis is the most common cause of acute abdomen requiring prompt surgery. CT and US are common imaging modality for diagnosis of appendicitis. Previous studies presented the high sensitivity and specificity of CT [1], [2], [3], [4]. A recent literature suggested that the major advantage of CT over US lies in the decreased false-negative rate for CT [4]. But, misdiagnosis of appendicitis on abdominal CT still occurs [5], [6].
To our best knowledge, there is no article which evaluated the complementary role of US for diagnosis of appendicitis in patients who underwent abdomen CT initially for diagnosis of appendicitis. Therefore, the purpose of our study was to estimate the complementary role of ultrasound evaluation in the diagnosis of acute appendicitis after abdominoplevic CT.
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Patients and imaging
This study was approved by the institutional review board for the retrospective review of the patients’ reports and images. Between January 2005 and November 2006, 1732 consecutive patients underwent appendix US, and 104 patients of them initially underwent abdomen CT 48 h or less before appendix US due to acute abdominal pain in our hospital, and were included in this study. The mean age of them was 32.9 years (range, 3–82 years; median age, 33 years). There were 67 females and 37 males.
In 35
Results
All patients with suggestive findings of appendicitis on US underwent appendectomy, and the pathology revealed appendicitis. Table 1 summarizes the results of CT and US, and pathologic or clinical diagnosis. In the three patients of definite appendicitis on CT, US also revealed same results. In the 32 cases of probably appendicitis on CT, there were seven (21.8%, 7 of 32) cases with discrepant US and CT findings of appendix. US showed normal appendix in five patients with probably secondary
Discussion
The misdiagnosis of appendicitis increases the risk of appendiceal perforation, resulting in higher rates of postoperative complications (39% for perforated appendicitis versus 8% for a simple appendicitis) [10], [11]. Therefore, appendectomy prior to perforation is the aim of treatment in patients with acute appendicitis. However, overdiagnosis of appendicitis leads to false-negative appendectomy. Thus, surgeons have made a great effort to decrease false-negative appendectomy rate as well as
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