Journal Article

How to diagnose acute appendicitis: ultrasound first

Mostbeck, Gerhard, Owens, Catherine M., Adam, E. Jane, Nyhsen, Christiane, Nielsen, Michael Bachmann, Claudon, Michel, Clevert, Dirk, Nicolau, Carlos

2016

Overview

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.

• Publisher: Springer Berlin Heidelberg,Springer Nature B.V,Springer
• Subject: Diagnostic Radiology / Human health and pathology / Imaging / Internal Medicine / Interventional Radiology / Life Sciences / Medicine / Medicine & Public Health / Neuroradiology / Opinion / Radiology / Ultrasound