Diagnostic value of ultrasonography in appendicitis.

Abstract

BACKGROUND: Clinical diagnosis of appendicitis is often difficult in atypical patients. OBJECTIVES: The authors aim to determine the diagnostic accuracy of ultrasonography (US) for acute appendicitis. MATERIAL AND METHODS: 121 consecutive patients with right lower abdomen pain were evaluated. Of them, 25 were excluded due to not having performed a preoperative US and 5 were obese (Body Mass Index > 30). A total of 91 patients were evaluated. The patients were assessed clinically and radiologically. Blood and urine analysis was carried out in all patients. US was performed with a Toshiba Fomio 8 brand machine with 3.75 and 8 MHz linear probes. Patients underwent an operation and an appendicectomy was done. Specimens were sent for histopathology to confirm appendicitis. RESULTS: Ultrasound supported the diagnosis of acute appendicitis in 58 (63.7%) patients. In the US with positive findings, 55 patients (94.8%) had inflamed appendices on histopathology and 5 (8.6%) had normal appendices. The overall sensitivity of ultrasonography was 71.4% and specificity was 78.5%. Positive predictive value (PPV), negative predictive value (NPV) and the diagnostic accuracy of ultrasonography are 94.8%, 33.3%, and 72.5% respectively. CONCLUSIONS: All diagnostic tests are adjunctive to the clinician. US should be the first step in the care of patients with right lower abdominal pain after the physical examination.