How to diagnose acute appendicitis: ultrasound first

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...

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Bibliographic Details
Published in:Insights into imaging 2016-04, Vol.7 (2), p.255-263
Main Authors: Mostbeck, Gerhard, Adam, E. Jane, Nielsen, Michael Bachmann, Claudon, Michel, Clevert, Dirk, Nicolau, Carlos, Nyhsen, Christiane, Owens, Catherine M.
Format: Article
Language:English
Subjects:
Diagnostic Radiology
Human health and pathology
Imaging
Internal Medicine
Interventional Radiology
Life Sciences
Medicine
Medicine & Public Health
Neuroradiology
Opinion
Radiology
Ultrasound
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Summary: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.
ISSN:1869-4101
1869-4101
DOI:10.1007/s13244-016-0469-6