Computed tomography in adults with atypical clinical presentation of acute appendicitis: comparison of findings with inflammatory serum markers

Abstract

Purpose: To evaluate both the potential usefulness of multidetector computed tomography (MDCT) in diagnosis of acute appendicitis (AA) in patients with atypical clinical presentation and to compare findings with C-reactive protein (CRP) and white cell count (WCC). Materials and methods: MDCT images in 69 patients with atypical presentation of AA were retrospectively reviewed by two readers in consensus. Diagnostic accuracy, sensitivity, specificity, positive and negative predictive values (PPV/NPV) were assessed considering histopathological evaluation as reference. Patients with AA were grouped in nonperforated vs perforated and CRP/ WCC were correlated using both Chi-square-test (χ 2 ) and receiver operating characteristic (ROC) curve analysis. Results: 39 patients underwent surgery and AA was confirmed histopathologically in 29/39 cases (74.4%), showing nonperforated AA (n=23, 79.3%) and perforated AA (n=6, 20.7%). In the remaining 10/39 patients (25.6%) diverticulitis of sigmoid colon was diagnosed (n=3); colitis (n=4); cholecystitis (n=3). Among the other 30/69 patients MDCT was either unremarkable (n=18) or differentials were detected (n=12). Diagnostic accuracy in patients with histopathologically confirmed AA was 95.7%, sensitivity was 90.6%, specificity was 93.6%, PPV was 83.0%, and NPV was 89.8%. All MDCT findings but calcified appendicoliths and CRP/WCC correlated statistical significant when AA was confirmed histopathologically (χ 2 =26.2; p<0.001). In contrary to WCC (p=0.11), CRP was significantly higher in patients with perforated AA than nonperforated AA (p<0.01), demonstrating an optimal cut-off value >121.5 mg/L. Conclusion: MDCT is required immediately to rule out perforation in patients with suspected AA despite atypical clinical presentation and a CRP level >121.5 mg/L.

Diagnostic Accuracy of Fact in Clinically Suspected Cases of Acute Appendicitis in Adolescents and Adults, Taking Surgical Findings as Gold Standard

“…Around 70% of acute appendicitis patients present with a typical history of right lower quadrant pain with tenderness on palpation, making clinical diagnosis relatively straightforward. The presence of atypical disease patterns, such as those seen in patients of extreme age, women of childbearing age, and those in whom the appendix is located in an unusual place, presents a diagnostic challenge 3 . The diagnosis of appendicitis may be missed or delayed due to these unusual presentations resulting in treatment delay and prolonged hospital admissions for observation 4 .…”