Acute appendicitis: Plain radiographic considerations

The Role of Radiological Imaging in the Diagnosis of Acute Appendicitis

“…Except for the presence of an appendicolith (fecalith) and possibly of a sentinel loop, the findings of acute appendicitis on plain radiographs (Table 2) are nonspecific and generally appear only in advanced disease (67)(68)(69)(70). Appendicolithiasis is said to be the most specific of the common findings of appendicitis but is identified in only 10% to 15% of all cases (71,72) -a considerably lower rate than those quoted in studies of ultrasonography and CT (vide infra).…”

“…Appendicolithiasis is said to be the most specific of the common findings of appendicitis but is identified in only 10% to 15% of all cases (71,72) -a considerably lower rate than those quoted in studies of ultrasonography and CT (vide infra). Plain x-rays are thus of little value in the early diagnosis of appendicitis (70,(73)(74)(75) and are actually less cost effective than either ultrasonography or CT (76,77). They are more helpful in detecting nonappendiceal causes of acute abdominal pain, including bowel obstruction, ureteral calculi and basal pneumonia (78).…”

Imaging in Suspected Appendicitis

“…Other nonspecific findings are abnormal gas pattern in the right iliac fossa, gas pattern in the right lower quadrant (ileocecal part or ascending colon topography) of the Klemm's sign [4], the presence of a sentinel loop, and loss of the right psoas margin. The use of barium would show indirect signs such as lack of filling of the appendiceal lumen or extrinsic impression of the cecum by an appendiceal abscess [5][6][7][8].…”