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On the Role of Ultrasonography and CT Scan in the Diagnosis of Acute Appendicitis

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Abstract

The purposes of this study were to revisit the utility of ultrasonography (USG) as a primary imaging modality in acute appendicitis (AA) and to establish the role of CT scan as a second-line/problem-solving modality. All cases of suspected AA were referred for urgent USG. USG was done with standard protocol for appendicitis. Limited computed tomographic (CT) scan [NCCT ± CECT (IV contrast only)] was done for the lower abdomen and pelvis where sonographic findings were equivocal. One hundred and twenty-one patients were referred for USG for suspected appendicitis. Eight-four patients underwent surgery for AA based on clinical as well as imaging findings, of whom 76 had appendicitis confirmed at histopathology. Three patients were misdiagnosed (3.6 %) on USG as appendicitis. Of 76 patients of appendicitis confirmed histopathologically, 63 (82.8 %) had features of appendicitis on USG and did not require any additional imaging modality. Of 121 patients, 12 (10 %) needed CT scan because of atypical features on USG. Of these 12 patients, seven had retrocecal appendicitis, and three high-up paracolic appendicitis. USG alone had sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 81, 88, 92.6, 71.6, and 83 %, respectively. When combined with CT scan in select cases, the sensitivity, specificity, PPV, NPV, and accuracy of combined USG + CT scan were 96 % (P = 0.0014), 89 %, 93 %, 93.5 % (P = 0.0001), and 93 % (P = 0.0484), respectively. Twenty-eight (23 %) patients were given alternative diagnosis on USG. Dedicated appendiceal USG should be used as a primary imaging modality in diagnosing or excluding AA. Appendiceal CT can serve as a problem-solving modality.

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Author notes

  1. Jyotindu Debnath

    Present address: Department of Radiology, Armed Forces Medical College, Pune, 411 040, Maharashtra, India

Authors and Affiliations

  1. Department of Radiodiagnosis and Imaging, 167 Military Hospital, Pathankot, 145001, Punjab, India

    Ankit Mathur

  2. Department of Surgery, 151 Base Hospital, Guwahati, India

    Rajesh Kumar

  3. Department of Surgery, 167 Military Hospital, Pathankot, India

    Pawan Sharma

  4. Pathology, 167 Military Hospital, Pathankot, India

    Nikhilesh Kumar & Shiv Pankaj Khanna

  5. Anesthesiology, 167 Military Hospital, Pathankot, India

    Nagaraj Shridhar

  6. Department of Surgery, Military Hospital, Dehradun, India

    Ashwani Shukla

Authors
  1. Jyotindu Debnath
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  2. Rajesh Kumar
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  3. Ankit Mathur
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  4. Pawan Sharma
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  5. Nikhilesh Kumar
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  6. Nagaraj Shridhar
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  7. Ashwani Shukla
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  8. Shiv Pankaj Khanna
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Correspondence to Jyotindu Debnath.

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Debnath, J., Kumar, R., Mathur, A. et al. On the Role of Ultrasonography and CT Scan in the Diagnosis of Acute Appendicitis. Indian J Surg 77 (Suppl 2), 221–226 (2015). https://doi.org/10.1007/s12262-012-0772-5

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  • DOI: https://doi.org/10.1007/s12262-012-0772-5

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