Value of short-interval computed tomography when sonography fails to visualize the appendix and shows otherwise normal findings

Bhavya R. Shah, Jessica Stewart, R. Brooke Jeffery, Eric W. Olcott

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

Objectives: The purpose of this study was to evaluate the type and incidence of disorders revealed by short-interval computed tomography (CT) in patients with suspected appendicitis after graded compression sonography fails to reveal the appendix and shows otherwise normal findings.

Methods: Computed tomographic findings and clinical courses were assessed retrospectively for 318 patients identified consecutively in a searchable database who met inclusion criteria specifying that sonography was the initial imaging examination for suspected appendicitis; sonography revealed nonvisualization of the appendix and otherwise normal results; and abdominopelvic CT was performed within 48 hours after sonography.

Results: Of the 318 patients, short-interval CT revealed normal findings in 250 (78.6%). Appendicitis was revealed in 52 (16.4%) others, of whom 7 had perforation and all of whom had pathologic results confirming these CT findings. Important alternative diagnoses other than appendicitis were revealed in 16 (5.0%) others, including 2 (0.6%) who required urgent surgery and 14 (4.4%) who did not. No significant differences were observed between adult patients (>18 years) and pediatric patients.

Conclusions: Most short-interval CT scans in this clinical setting reveal normal findings, and relatively few disclose appendicitis or disorders that require urgent surgery. In view of concerns regarding radiation exposure associated with CT, these observations argue for the development of clinical triage methods that differentiate patients who are likely to benefit from short-interval postsonography CT from those who are not.

Original languageEnglish (US)
Pages (from-to)1589-1595
Number of pages7
JournalJournal of Ultrasound in Medicine
Volume33
Issue number9
DOIs
StatePublished - Sep 1 2014

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Keywords

  • Appendicitis
  • Diagnostic imaging
  • Gastrointestinal ultrasound
  • Radiation protection
  • Sonography
  • Spiral computed tomography

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging

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