Imaging of acute appendicitis: Advances

Abstract

We read with interest the review by Teng et al, who summarized the current approach to the diagnosis and treatment of acute appendicitis (AA). Also, the article summarizes the clinical scoring systems very effectively. In one of the previous studies conducted by our research group, we showed that the use of the Alvarado score, ultrasound and C-reactive protein values in combination provides a safe confirmation or exclusion of the diagnosis of AA. Computed tomography is particularly sensitive in detecting periappendiceal abscess, peritonitis and gangrenous changes. Computed tomography is not a good diagnostic tool in pediatric patients because of the ionizing radiation it produces. Ultrasound is a valuable diagnostic tool to differentiate AA from lymphoid hyperplasia. Presence of fluid collection in the periappendiceal and lamina propria thickness less than 1 mm are the most effective parameters in differentiating appendicitis from lymphoid hyperplasia. Although AA is the most common cause of surgical acute abdomen, it remains an important diagnostic and clinical challenge. By combining clinical scoring systems, laboratory data and appropriate imaging methods, diagnostic accuracy and adherence to treatment can be increased. Lymphoid hyperplasia and perforated appendicitis present significant diagnostic challenges in children. Additional ultrasound findings are increasingly defined to differentiate AA from these conditions.

Keywords: Acute appendicitis; Inflammation; Acute abdomen; Perforation

Core Tip: Despite the fact that acute appendicitis is the most common cause of acute abdomen, it remains a diagnostic and clinical challenge. When the ultrasound, Alvarado scoring and C-reactive protein are used in conjunction to diagnose acute appendicitis, the diagnosis can be safely confirmed or ruled out. Computed tomography scans are extremely sensitive in detecting complications from acute appendicitis. Computed tomography scans are especially effective at detecting periappendix abscesses, peritonitis and gangrenous changes. Because of the ionizing radiation it emits, computed tomography is not a good diagnostic tool in pediatric patients. In pediatric patients, ultrasound should be the preferred method.