A Study to Evaluate the Combined Use of Alvarado Score and Imaging for Diagnosis of Acute Appendicitis

Abstract

Thyroid pathology is very common in general population, even when on inspection no abnormality is detected, nodules are seen on ultrasound sonography (USG). We are describing importance of peripheral halo sign in the diagnosis of benign nodules. Among all the endocrine gland lesions noted in India, thyroid lesion is the most common. In about 19 - 60 % of the adult population thyroid nodules are seen; however, less than 1 % of the thyroid nodules are malignant. Halo seen on ultrasound near the thyroid is considered as reliable and specific sign of benignity. 1 The morphological characteristics that suggest that the thyroid nodule is benign are echogenicity of thyroid gland in that being the identical echo signal or being moderately hyperechogenic corresponding to surrounding normal thyroid tissue. The solid nodule may be accompanied by a hypoechoic halo, which represents compressed thyroid tissue, fibrous connective tissue and vessels. The cystic nodule lesion contains colloid, and this appears as a hyper-echogenic spot with “comet-tail shadowing or ring-down sign”.2 The spongiform appearance on ultrasound has specificity of 99.7 % for benign disease it has 98.5 % negative predictive value for malignancy. 3,4 At the peripheries of the nodule, complete eggshell calcification is noted.5 A thyroid nodule with the above-mentioned characteristics is considered to be benign nodule and it does not require fine-needle aspiration cytology (FNAC) and in such patients there is neither a risk of malignancy nor a follow up USG is recommended.2 In benign thyroid lesion, there is rapid and controlled growth of thyroid cells compressing the surrounding thyroid parenchyma appearing as the echogenic rim called as sonolucent halo, on the contrary, malignant lesion has spontaneous but uncontrolled growth of the cells which lack cellular cohesion causing incomplete halo.6

A prospective cohort study to assess the clinical profile of acute appendicitis and evaluate the combined use of modified Alvarado score and ultrasonography in a tertiary care center in India

“…These findings show little to no variability with the findings in previous studies. 14,15,18,23,24 In our study, all cases were managed surgically through laparoscopic or open appendectomy and all the cases (n=82) recovered with no mortality. Appendectomy was complicated by surgical site infection in five patients, which was managed conservatively with broad spectrum IV antibiotics (Figure 5).…”

“…The same study also considered CECT findings of patients along with USG findings despite the fact that CECT can prove to be a major financial burden in the Indian public healthcare scenario. 14 Another study conducted in northern India by Kansakar et al, used MAS as well as USG findings to evaluate the efficacy of the combined use of both of them in predicting acute appendicitis, thus overcoming the shortcomings of study conducted by Mukhopadhyay et al 15 Our hospital is a tertiary care center situated in northwestern Uttar Pradesh in India and it receives a humongous patient load of appendicitis patients. Thus, in this study, we have tried to replicate the methodology applied by the above studies on our cohort of patients to check if the results hold true for our scenario or not.…”

A systematic review and meta-regression for validation of the Alvarado score as a tool for predicting acute appendicitis

“…Mukhopadhyay et al . 55 in their prospective observational study with 118 patients found that combined use of imaging with AS can prevent surgical complications and minimize NARs.…”