Morphologic criteria of vermiform appendix on computed tomography and a possible risk of developing acute appendicitis (original) (raw)
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Journal of Bahria University Medical and Dental College, 2022
Objective: To evaluate the anatomical positions of vermiform appendix and its association with acute appendicitis on Multidetector computed tomography (MDCT). Study design and setting: A cross sectional study based on hospital database was carried out in Department of Anatomy in collaboration with Department of Radiology, Liaquat National Hospital. Methodology: A total of three hundred and six 306 adult urban patients CT axial images were evaluated retrospectively over period of 6 months from March 2021 to August 2021 who had abdominal MDCT scan for acute abdomen after getting approval from ethical committee to find out anatomical variations of position of vermiform appendix in a tertiary care hospital among adult urban Karachi population and its association with appendicitis. Data was analyzed using SPSS version 25. All categorical variables were summarized as frequencies and percentages. Result: In present study 159(52%) were males and 147(48%) were females with mean age of 32.97 ...
Evaluation of normal appendix vermiformis in adults with multidetector computed tomography
Clinical Imaging, 2012
To determine the utility of different contrast enhancement phases (unenhanced, arterial, and venous), slice thicknesses (0.5, 3, and 5 mm), and planes (axial and coronal) in the evaluation of appendix vermiformis (AV) on multidetector computed tomography (MDCT), CT examinations of 600 patients were obtained. No significant difference was found between the different imaging planes, slice thicknesses, and contrast enhancement phases in terms of detection rates of AV. The mean diameter of AV in the axial plane (5.93±0.06 mm) was significantly lower than that in the coronal plane (6.18±0.06 mm). Evaluation of AV on MDCT is enhanced by combined interpretation on axial and coronal planes.
Role of Computed Tomography in Diagnosis of Appendicitis and Its Complications
Zagazig University Medical Journal, 2019
Background: Appendicitis and its complications are the most commonly acute abdominal pain that require surgical intervention. Patients may present with a wide variety of clinical manifestation. The clinical diagnosis is based primarily on the patient history, physical examinations and white blood cell count. Clinical diagnosis mostly straight forward in patients presenting with classic signs and symptoms, while diagnostic confusion and delay in treatment may occur in patients with atypical presentations. MSCT is a highly accurate means for establishing the diagnosis. Objective: The aim of the work is to describe the value and role of Multi-slice computed tomography in diagnosing appendicitis and its complications. Methods: This study retrospective study was conducted on patients with right lower quadrant or right flank pain. The study was conducted in Health Insurance hospitals Radiology department on Fifteen patients with right lower quadrant pain or right flank pain. Results: In the present study, we concentrate on continuity and thickness of the appendiceal wall. The normal appendix thickness is less than 1 mm. When appendix got inflamed, it usually appears thickened, asymmetric and enhancing with i.v. contrast from 1 to 3 mm thickness. Conclusion: MSCT is helpful for accurate and prompt diagnosis in suspected cases of appendicitis & its complications and conditions that mimic appendicitis.
The role of CT in decision for acute appendicitis treatment
Diagnostic and Interventional Radiology
Acute appendicitis is the most common cause of acute abdomen requiring surgery. Although the standard treatment has been surgery, it has been seen in recent years that treatment is possible with antibiotics and non-operative observation. In this study, our aim is to determine whether the computed tomography (CT) findings in patients diagnosed with acute appendicitis can be used for directing treatment. METHODS A retrospective analysis was conducted on 138 patients with acute appendicitis who underwent CT between 2015 and 2019. In this study, medical treatment group (n = 60) versus surgical treatment group (n = 78) and successful antibiotic treatment group (n = 23) versus unsuccessful antibiotic treatment group (n = 14) were compared. Appendiceal wall thickness, appendiceal diameter, the severity of mural enhancement, intra-abdominal free fluid, the severity of periappendiceal fat stranding, size of pericecal lymph node, appendicolith, adjacent organ findings, and the CT appendicitis score of groups were compared with Pearson Chi-square and Mann-Whitney U tests. Multivariable logistic regression was used to identify predictors of surgical treatment, expressed as odds ratios (ORs) with 95% CIs. Diagnostic efficacies of appendiceal diameter, the CT appendicitis score, and the developed model were quantified by receiver operating characteristic curves. RESULTS Appendiceal diameter (P < .001), adjacent organ findings (P = 0.041), the CT appendicitis score (P < .001), the severity of periappendiceal fat stranding (P = .002), appendicolith (P = .001), and intra-abdominal free fluid (P < .001) showed statistically significant differences between the medical and surgical treatment groups. According to the logistic regression test, if the patients are with appendiceal diameter ≥13 mm (
Appendiceal CT in 140 cases diagnostic criteria for acute and necrotizing appendicitis
Clinical Imaging, 1998
citis . Excellent results have been reported for both US and CT, with accuracy of 90% to 95% in patients with suspected acute appendicitis. Thin collimation (5 mm), intravenous contrast enhancement, several studies (17-20, 29, 30). Direct visualization of the abnormal appendix gives sectional imaging a 1-second scan times, and supplementary cecal air insufflation were emphasized. CT accuracy was 98% substantial advantage over conventional radiography, which relies mainly on indirect signs for diagnosing overall (137/140), and 99% in the 124 cases with early surgery. Necrotizing appendicitis was diagnosed by appendicitis (41-45). US is ideal for initial imaging of thin patients, premenopausal and pregnant CT with 86% accuracy and 90% positive predictive value. © Elsevier Science Inc., 1998 women (20, 23, 25, 30), and pediatric patients (33-40). CT is more sensitive than US in the diagnosis of acute appendicitis and its complications (46), and is KEY WORDS: most useful for patients where sonography is found Appendicitis; Appendix CT; Appendix; Appendix abscess to be, or likely to be, nondiagnostic. In this article we report on a series of 140 consecutive surgically proven CT scans in patients with equivocal clinical From the Departments of Radiology (nant women, and pediatric patients were referred CLINICAL IMAGING 1998;22:252-271
European radiology, 2017
To determine the diagnostic accuracy of abdominal CT with compression to the right lower quadrant (RLQ) in adults with acute appendicitis. 168 patients (age range, 18-78 years) were included who underwent contrast-enhanced CT for suspected appendicitis performed either using compression to the RLQ (n = 71) or a standard protocol (n = 97). Outer diameter of the appendix, appendiceal wall thickening, luminal content and associated findings were evaluated in each patient. Kruskal-Wallis, Fisher's and Pearson's chi-squared tests were used for statistical analysis. There was no significant difference in the mean outer diameter (MOD) between compression CT scans (10.6 ± 1.9 mm) and standard protocol (11.2 ± 2.3 mm) in patients with acute appendicitis (P = 1). MOD was significantly lower in the compression group (5.2 ± 0.8 mm) compared to the standard protocol (6.5 ± 1.1 mm) (P < 0.01) in patients without appendicitis. A cut-off value of 6.75 mm for the outer diameter of the app...
Polish Journal of Radiology
Purpose: The tip of the appendix may be located in various areas of the abdominal cavity due to its variable length and/or the changeable position of the caecum. Although in the case of an atypical position the tip is usually located behind the caecum, there are possible locations that occur very rarely. Therefore, in the case of appendicitis the symptoms may lead to the wrong diagnosis. The aim of this study is to present the most atypical locations of the tip of the appendix found on CT (computed tomography) scans and thus help to avoid misdiagnoses. Imaging findings: The most unusual locations of the tip of the appendix found in healthy subjects included: left inferior quadrant, along the lower edge of the liver near the gallbladder and the right kidney, the tip touching the duodenum, the rectum or appendages, and a long appendix located in the scrotum as the content of a hernia. In these positions, appendicitis may mimic acute diverticulitis, cholecystitis, duodenal ulcer, duodenitis, enteritis, or adnexal or testis pathologies. Conclusions: It is important to be aware of atypical locations of the appendix because appendicitis in an unusual area may mimic other acute abdominal diseases and delay the proper treatment.
The role of computed tomography in the diagnosis of acute appendicitis
The American Journal of Surgery, 1999
BACKGROUND: Routine contrast-enhanced computed tomography (CECT) has been described as an accurate diagnostic imaging modality in patients with acute appendicitis. However, most patients with acute appendicitis can be diagnosed by clinical findings and physical exam alone. The role of CECT in patients suspected of having appendicitis but with equivocal clinical exams remains ill defined. METHODS: One hundred and seven consecutive patients who were thought to have appendicitis but with equivocal clinical findings and/or physical exams were imaged by CECT over a 12month period. Oral and intravenous contrast-enhanced, spiral abdominal and pelvic images were obtained using 7-mm cuts. CECT images were interpreted by a board-certified radiologist. Main outcome measures included CECT sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy in the diagnosis of acute appendicitis, comparing CECT with ultrasound, and determining the impact of CECT on the clinical management of this patient population. RESULTS: A group of 107 patients consisting of 44 males (41%) and 63 females (59%) with a median age of 33 years (range 13 to 89 years) were imaged with CECT to evaluate suspected appendicitis. Of the 107 CECTs performed, 11 false-positive and 3 false-negative readings were identified, resulting in a sensitivity of 92%, specificity of 85%, PPV of 75%, NPV of 95%, and an overall accuracy of 90%. Forty-three patients were imaged with ultrasound and CECT, and CECT had significantly better sensitivity and accuracy (30% versus 92% and 69% versus 88%, P <0.01). With regard to clinical management, 100% (36/36) of patients with appendicitis, and 4.2% (3/71) of patients without appendicitis underwent appendectomy. Therefore, the overall negative appendectomy rate was 7.6% (3/39). CONCLUSIONS: CECT is a useful diagnostic imaging modality for patients suspected of having acute appendicitis but with equivocal clinical findings and/or physical exams. CECT is more sensitive and accurate than ultrasound and is particularly useful in excluding the diagnosis of appendicitis in those without disease.