The Diagnostic Accuracy of Sonography, With Graded Compression to Image Acute Appendicitis Compared to Histopathologic Results

Abstract

Acute appendicitis is the most common cause of acute abdominal pain that can necessitate emergency surgery. 1,2 Despite its prevalence, the diagnosis of appendicitis can be difficult and filled with pitfalls because of the absence of a pathognomonic sign or symptom, the poor predictive value of associated laboratory testing, and its different diagnostic presentations. 3,4 An incorrect diagnosis of appendicitis has led to a high rate (8-30%) of unnecessary appendectomies. 5,6 In fact, following significant progress in accuracy, imaging is now regarded as an essential part of the diagnostic workup of appendicitis. 7 Among the imaging methods currently used in the clinical practice, diagnostic medical sonography (DMS) is simple, easily available, noninvasive, convenient and cost effective choice. The sonographic diagnosis of acute appendicitis was first introduced by Puylaert in 1986, one hundred years after the publication of the first paper on acute appendicitis by Fitz. 8 DMS, with graded compression, is performed and aims to optimize visualization of the appendix. 9,10 An inflamed appendix typical is noncompressible and can be imaged as a blind-ended, tubular structure with laminated wall, that arises from the base of the caecum. It is nonperistaltic, and the diameter of the inflamed appendix should be greater than 6 mm (Figure 1). Appendicoliths appear as bright echogenic foci with a distal acoustic shadowing, and their visualization can be an added diagnostic finding. Similarly, there may be increased echogenicity of the periappendiceal fat and 712196J DMXXX10.