Diagnostic Value of Ultrasound in Patients Suspected Acute Appendicitis
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Abstract
Background: Acute appendicitis is a common surgical problem worldwide. Radiologic investigations haveroles in the patient with equivocal sign and symptoms for acute appendicitis to suggest the likely diagnosis and to exclude other causes of abdominal pain, causing proper management and less complication. Nowadays, ultrasound has increased roles as diagnostic tool to evaluate patientssuspected acute appendicitis due to no radiation exposure and cheaper than CT.
Objective: To evaluate the diagnostic accuracy of ultrasound in patients with suspected acute appendicitis and right lower quadrant pain.
Methods: This diagnostic accuracy researchis retrospective cross-sectional design with population-based data collection. Ninety-nine patients with right lower quadrant pain were investigated with ultrasonography to rule out acute appendicitis during 1st. August 2020 and 24th. February 2021. The findings from ultrasonography were reviewedwhether the appendix was visualized or not and also recorded other findings. Then the results were compared to pathological diagnosis for patients who underwent surgery and review the clinical record before discharge or follow-up record in non-operative patients.
Results: Diagnostic performance of the ultrasound in diagnosis acute appendicitis in this study shows sensitivity 50%(95% CI;31.3-68.7), specificity 95.7% (95% CI;87.8-99.1)positive predictive value83.3%(95% CI; 58.6-96.4) and negative predictive value81.5% (95% CI; 71.3-89.2). The appendix was not visualized in 76.8% of the examinations,visualized appendix size > 6 mm. 18.2%, echogenic peritoneal fat 3%, free fluid 12.1% and fluid collection 6.1%
Conclusion: Ultrasound shows low sensitivity but high specificity for acute appendicitis. Therefore,ultrasound could be used as the first imaging test. But if the appendix is not visualized but clinically suspected acute appendicitis, correlation with clinical context or further CT is considered.
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