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Insights into Imaging
Published in: Insights into Imaging 2/2016

Open Access 01-04-2016 | Opinion

How to diagnose acute appendicitis: ultrasound first

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

Published in: Insights into Imaging | Issue 2/2016

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Abstract

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.
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Metadata
Title
How to diagnose acute appendicitis: ultrasound first
Authors
Gerhard Mostbeck
E. Jane Adam
Michael Bachmann Nielsen
Michel Claudon
Dirk Clevert
Carlos Nicolau
Christiane Nyhsen
Catherine M. Owens
Publication date
01-04-2016
Publisher
Springer Berlin Heidelberg
Published in
Insights into Imaging / Issue 2/2016
Electronic ISSN: 1869-4101
DOI
https://doi.org/10.1007/s13244-016-0469-6

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