The clinical symptoms of acute appendicitis can be so characteristic that there is no difficulty in making the correct diagnosis. In some patients, however, the clinical findings may be obscure or minimal. In these patients, imaging studies may be required to make a correct diagnosis and permit prompt surgical intervention before perforation occurs. Today, this is accomplished rapidly and accurately by ultrasound and computed tomography. In the past, abdominal radiography has traditionally been considered an essential part of the workup of patients presenting with acute abdominal pain. Although it has a low diagnostic yield, this procedure is still frequently performed in patients with abdominal pain suggestive of acute appendicitis to detect abnormal bowel gas patterns or an appendicolith. There is no current indication for barium enema examination for acute appendicitis, but a short presentation of this technique provides younger readers an idea of how appendicitis was diagnosed before the age of cross-sectional imaging.
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The author expresses thanks to Wolters Kluwer Publishers for permitting him to use illustrations from their book, Gastrointestinal Radiology: A Pattern Approach (4th edition). Philadelphia: Lippincott, 2002.
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