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Related Concept Videos

Appendicitis-II: Diagnostic Studies and Management01:29

Appendicitis-II: Diagnostic Studies and Management

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Diagnosing and managing appendicitis requires a structured and comprehensive approach that spans from initial assessment to postoperative care. Here is an overview of the process:
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
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Appendicitis-I: Introduction01:22

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The appendix, a small, narrow, blind tube extending from the inferior part of the cecum, is widely regarded as a vestigial organ, having lost much of its original function through evolution. Despite its diminished role, the appendix can become inflamed, a condition known as appendicitis.
Etiology: Appendicitis can arise from various causes, primarily rooted in the obstruction of the appendix lumen. Factors contributing to this obstruction include fecal accumulation, lymphoid hyperplasia and, in...
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Ultrasonography01:17

Ultrasonography

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Ultrasonography is an imaging technique that uses high-frequency sound waves to visualize the body's internal structures. It is a non-invasive and safe procedure that does not involve the use of ionizing radiation, making it widely used in various medical fields. Ultrasonography is used to study heart function, blood flow in the neck or extremities, certain conditions such as gallbladder disease, and fetal growth and development.
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Abdominal ultrasonography, commonly known as abdominal ultrasound, is a vital, non-invasive medical imaging technique widely used in healthcare.
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To promote clear communication, for instance, about the location of a patient's abdominal pain or a suspicious mass, anatomists and clinicians typically use imaginary lines to categorize the abdominopelvic cavity into either four quadrants or nine regions to identify organs in the cavity.
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CT following US for possible appendicitis: anatomic coverage.

Martin E O'Malley1, Fawaz Alharbi2,3, Tanya P Chawla4

  • 1Joint Department of Medical Imaging, University of Toronto, Princess Margaret Hospital, 3-920, 610 University Avenue, Toronto, Ontario, M5G 2 M9, Canada. martin.o'malley@uhn.ca.

European Radiology
|November 1, 2015
PubMed
Summary

Computed tomography (CT) from L2 to the pubic symphysis can diagnose appendicitis after inconclusive ultrasound, reducing radiation exposure. This targeted CT approach significantly decreases radiation dose compared to standard scans.

Keywords:
AnatomyAppendicitisMultidetector computed tomographyRadiationUltrasound

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Area of Science:

  • Radiology
  • Medical Imaging
  • Diagnostic Procedures

Background:

  • Ultrasound (US) can be inconclusive for diagnosing appendicitis.
  • Computed tomography (CT) is often used as a follow-up imaging modality.
  • Standard CT protocols may involve broader anatomic coverage than necessary.

Purpose of the Study:

  • To define optimal superior-inferior anatomic borders for CT in suspected appendicitis cases with prior inconclusive US.
  • To evaluate the potential reduction in CT coverage and radiation exposure using a targeted approach.

Main Methods:

  • Retrospective analysis of 99 patients with suspected appendicitis and inconclusive US, followed by CT.
  • Two radiologists determined the minimum CT coverage (superior-inferior borders) needed for diagnosis.
  • Comparison of targeted coverage with standard abdominal/pelvic CT protocols.

Main Results:

  • The optimal CT coverage for diagnosing or excluding appendicitis was from the superior border of L2 to the superior border of the pubic symphysis.
  • This targeted coverage represents a 30-55% reduction in anatomic coverage compared to standard CT.
  • Appendicitis was diagnosed in 26% of patients, with nonspecific abdominal pain being the most common diagnosis (51%).

Conclusions:

  • Targeted CT from L2 to the pubic symphysis is effective for evaluating suspected appendicitis after inconclusive US.
  • This approach significantly reduces patient exposure to ionizing radiation.
  • Reduced anatomic coverage in CT can lead to substantial radiation dose savings.