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==Overview==
==Overview==
[[Ultrasound]]s are a useful tool for diagnosing [[appendicitis]]. There are some limitations to the information provided by ultrasounds, such as sometimes ultrasonographic images of the [[iliac fossa]] show no abnormalities despite the presence of appendicitis.  Whenever available, [[CT scan]]s are preferred over ultrasounds for diagnosing appendicitis.
Ultrasound may be helpful in the diagnosis of appendicitis. Findings that are supportive of the diagnosis of appendicitis include noncompressible, dilated appendix, appendicolith, echogenic prominent [[pericaecal]] fat and periappeniceal fluid collection.
 
==Ultrasound==
==Ultrasound==
===Use as a Diagnostic Tool===
*[[CT scan]]s are preferred over ultrasounds for diagnosing appendicitis. However, ultrasound imaging presents with the least amount of radiation and is therefore the investigation of choice for young patients.<ref name="pmid23902717">{{cite journal |vauthors=Pinto F, Pinto A, Russo A, Coppolino F, Bracale R, Fonio P, Macarini L, Giganti M |title=Accuracy of ultrasonography in the diagnosis of acute appendicitis in adult patients: review of the literature |journal=Crit Ultrasound J |volume=5 Suppl 1 |issue= |pages=S2 |year=2013 |pmid=23902717 |pmc=3711731 |doi=10.1186/2036-7902-5-S1-S2 |url=}}</ref><ref name="pmid26883138">{{cite journal |vauthors=Mostbeck G, Adam EJ, Nielsen MB, Claudon M, Clevert D, Nicolau C, Nyhsen C, Owens CM |title=How to diagnose acute appendicitis: ultrasound first |journal=Insights Imaging |volume=7 |issue=2 |pages=255–63 |year=2016 |pmid=26883138 |pmc=4805616 |doi=10.1007/s13244-016-0469-6 |url=}}</ref><ref name="pmid25358207">{{cite journal |vauthors=Hussain S, Rahman A, Abbasi T, Aziz T |title=Diagnostic accuracy of ultrasonography in acute appendicitis |journal=J Ayub Med Coll Abbottabad |volume=26 |issue=1 |pages=12–7 |year=2014 |pmid=25358207 |doi= |url=}}</ref>
* [[Ultrasonography]] and [[Doppler sonography]] provide useful means to detect appendicitis, especially in children.
*The ultrasound technique is known as graded compression, which uses linear probes over sites of maximal thickness and gradually increasing pressure exerted to displace normal overlying bowel gas.  
*  In some cases (15% approximately), however, ultrasonography of the [[iliac fossa]] does not reveal any abnormalities despite the presence of appendicitis.
** This is especially true of early appendicitis before the appendix has become significantly distended and in adults where larger amounts of fat and bowel gas make actually seeing the appendix technically difficult.
* Despite these limitations, in experienced hands sonographic imaging can often distinguish between appendicitis and other diseases with very similar symptoms such as [[Lymphadenitis|inflammation of the lymph nodes]] near the appendix or pain originating from other pelvic organs such as the [[ovaries]] or [[fallopian tubes]].


===Diagnostic Comparison to a CT Scan===
===Findings Supportive of Appendicitis===
* According to a systematic review from UC-San Francisco comparing [[ultrasound]] vs. CT scan, a [[CT scan]] is more accurate than ultrasound for the diagnosis of [[appendicitis]] in adults and adolescents.  
Findings that are supportive of the diagnosis of appendicitis include:<ref name="rad1">Appendicitis. Radiopaedia.org (27 August 2015). http://radiopaedia.org/articles/appendicitis  Accessed on December 7, 2015</ref>
* CT scan has a sensitivity of 94%, specificity of 95%, a positive likelihood ratio of 13.3 (CI, 9.9 to 17.9), and a negative likelihood ratio of 0.09 (CI, 0.07 to 0.12).
*Aperistaltic, noncompressible, dilated appendix (>6 mm outer diameter)
* Ultrasonography had an overall sensitivity of 86%, a specificity of 81%, a positive likelihood ratio of 5.8 (CI, 3.5 to 9.5), and a negative likelihood ratio of 0.19 (CI, 0.13 to 0.27).<ref>{{cite journal |author=Terasawa T, Blackmore CC, Bent S, Kohlwes RJ |title=Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents |journal=Ann. Intern. Med. |volume=141 |issue=7 |pages=537–46 |year=2004 |month=October |pmid=15466771 |doi= |url=}}</ref>
*[[Appendicolith]]
*Distinct appendieal wall layers
*Echogenic prominent [[pericaecal]] fat
*Periappeniceal fluid collection
[[Image:Appendicitis-perforated.png|thumb|center|500px|Inflammed appendix associated with perforation<br>Source:Case courtesy of Dr Maulik S Patel, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/26853">rID: 26853</a>]]


==References==
==References==
{{reflist|2}}
{{Reflist|2}}
[[Category:Primary care]]
[[Category:emergency medicine]]
[[Category:Inflammations]]
[[Category:Medical emergencies]]
[[Category:General surgery]]
[[Category:Gastroenterology]]
[[Category:Disease]]
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Latest revision as of 20:28, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Farwa Haideri [2]

Overview

Ultrasound may be helpful in the diagnosis of appendicitis. Findings that are supportive of the diagnosis of appendicitis include noncompressible, dilated appendix, appendicolith, echogenic prominent pericaecal fat and periappeniceal fluid collection.

Ultrasound

  • CT scans are preferred over ultrasounds for diagnosing appendicitis. However, ultrasound imaging presents with the least amount of radiation and is therefore the investigation of choice for young patients.[1][2][3]
  • The ultrasound technique is known as graded compression, which uses linear probes over sites of maximal thickness and gradually increasing pressure exerted to displace normal overlying bowel gas.

Findings Supportive of Appendicitis

Findings that are supportive of the diagnosis of appendicitis include:[4]

  • Aperistaltic, noncompressible, dilated appendix (>6 mm outer diameter)
  • Appendicolith
  • Distinct appendieal wall layers
  • Echogenic prominent pericaecal fat
  • Periappeniceal fluid collection
Inflammed appendix associated with perforation
Source:Case courtesy of Dr Maulik S Patel, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/26853">rID: 26853</a>

References

  1. Pinto F, Pinto A, Russo A, Coppolino F, Bracale R, Fonio P, Macarini L, Giganti M (2013). "Accuracy of ultrasonography in the diagnosis of acute appendicitis in adult patients: review of the literature". Crit Ultrasound J. 5 Suppl 1: S2. doi:10.1186/2036-7902-5-S1-S2. PMC 3711731. PMID 23902717.
  2. Mostbeck G, Adam EJ, Nielsen MB, Claudon M, Clevert D, Nicolau C, Nyhsen C, Owens CM (2016). "How to diagnose acute appendicitis: ultrasound first". Insights Imaging. 7 (2): 255–63. doi:10.1007/s13244-016-0469-6. PMC 4805616. PMID 26883138.
  3. Hussain S, Rahman A, Abbasi T, Aziz T (2014). "Diagnostic accuracy of ultrasonography in acute appendicitis". J Ayub Med Coll Abbottabad. 26 (1): 12–7. PMID 25358207.
  4. Appendicitis. Radiopaedia.org (27 August 2015). http://radiopaedia.org/articles/appendicitis Accessed on December 7, 2015

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