Diagnosis of primary pyomyositis

Abstract

Alternative guide to utilization of computed tomography in appendicitisRegarding Alvarado score: a guide to computed tomography (CT) utilization in appendicitis, 1 I use an alternative guide to utilization of CT in appendicitis that is based on the age and sex of the patient. Each group of patients have different causes of right iliac fossa (RIF) pain, the appendicitis assumes different position in the ladder of differential diagnosis of RIF pain and each group have different risk rate from CT. The risk is higher in younger ages and in female. 2 For patients with age over 40, I use CT more routinely as the advantages exceed the risks. It achieves the lowest negative result, avoids unnecessary operation in older patients with as expected higher comorbidities, and helps to diagnose other more common causes of RIF pain in that group such as caecal diverticulitis, caecal carcinoma and even Iliac artery aneurysm. The increased risk of cancer from CT is lower in older ages. 2 For male children up to the age of 20 and for female children up to the age of 13, mesenteric adenitis is a more common cause of pain; I am very reluctant to give them CT radiation. The American Cancer Society estimates that in the future, cancer will develop from every 300 abdomen/pelvis scans. 3 For women at the ages of 14-40, the tubovarian conditions are the more common causes of RIF pain; it is safer to rely on ultrasound, observation, diagnostic laparoscopy and magnetic resonance imaging, which is as sensitive and specific as CT. 4 This group is at a higher risk of cancer from CT than both the men at same age as well as older women. 2,3 For men at the ages 20-40, a low negative rate can be achieved on clinical ground and CT is only occasionally needed. References 1. Tan W, Pek W, Kabir T et al. Alvardo score: a guide to computed tomography utilization in appendicitis. ANZ J. Surg. 2013; 83: 748-52. 2. Einstein A, Henzlova M, Rajagopalan S. Estimating risk of cancer associated with radiation CT angiography. JAMA 2007; 298: 317-23. 3. Miglioretti L, Johnson E, Williams A et al. The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr. 2013; 167: 700-7. 4. Stoker J. Magnetic resonance imaging and the acute abdomen. Br. J. Surg. 2008; 95: 1193-4.