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Seifarth FG, Barry JN, Forse CL, Plesec TP, Worley S, Mahajan L. Appendiceal Follicular Hyperplasia: A Possible Indicator for Chronic Appendicitis in Children. J Laparoendosc Adv Surg Tech A 2023; 33:1005-1010. [PMID: 37327364 DOI: 10.1089/lap.2023.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023] Open
Affiliation(s)
- Federico G Seifarth
- Division of Pediatric Surgery, WVU Medicine Children's Hospital, Morgantown, West Virginia, USA
| | - Jessica N Barry
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | - Catherine L Forse
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, California, USA
| | - Thomas P Plesec
- Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Sarah Worley
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Lori Mahajan
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
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2
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Galaviz VD, Nguyen AD, Sticco PL, Downing KT. Appendectomy in endometriosis: an update on surgical indications and management of uncommon diseases. Curr Opin Obstet Gynecol 2023; 35:377-382. [PMID: 37144569 DOI: 10.1097/gco.0000000000000879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE OF REVIEW Abnormal appendiceal disease is commonly encountered following an appendectomy when performed in patients with endometriosis. Appendiceal endometriosis is the most notable finding and can affect up to 39% of patients with endometriosis. Despite this knowledge, guidelines for performing an appendectomy have not been formally established. In this article, we review the surgical indications for an appendectomy at the time of endometriosis surgery and discuss the management of other diseases that may be encountered following the histopathologic evaluation of an excised appendix. RECENT FINDINGS Removal of the appendix in patients with endometriosis contributes to optimal surgical management. Relying on abnormal appendiceal appearance for removal may leave endometriosis-affected appendices. For this reason, utilizing risk factors to guide surgical management is essential. Common appendiceal diseases are sufficiently managed with appendectomy. Uncommon diseases may require further surveillance. SUMMARY Emerging data in our field support the performance of an appendectomy at the time of endometriosis surgery. Guidelines for performing a concurrent appendectomy should be formalized to encourage preoperative counselling and management for patients with risk factors for appendiceal endometriosis. Abnormal diseases is frequently encountered after appendectomy in the setting of endometriosis surgery and further management is based on the histopathology of the specimen.
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Borruel Nacenta S, Ibáñez Sanz L, Sanz Lucas R, Depetris M, Martínez Chamorro E. Update on acute appendicitis: Typical and untypical findings. RADIOLOGÍA (ENGLISH EDITION) 2023; 65 Suppl 1:S81-S91. [PMID: 37024234 DOI: 10.1016/j.rxeng.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/08/2022] [Indexed: 04/08/2023]
Abstract
Acute appendicitis is the most common indication for emergency abdominal surgery throughout the world and a common reason for consultation in emergency departments. In recent decades, diagnostic imaging has played a fundamental role in identifying acute appendicitis, helping to reduce the rate of blind laparotomies and hospital costs. Given the results of clinical trials supporting the use of antibiotic therapy over surgical treatment, radiologists need to know the diagnostic criteria for complicated acute appendicitis to be able to recommend the best treatment option. This review aims not only to define the diagnostic criteria for appendicitis in different imaging modalities (ultrasonography, computed tomography, and magnetic resonance imaging), but also to explain the diagnostic protocols, atypical presentations, and other conditions that can mimic appendicitis.
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Actualización de la apendicitis aguda: hallazgos típicos y atípicos. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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5
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Ucar Karabulut K, Erinanc H, Yonar A, Kisinma A, Ucar Y. Correlation of histological diagnosis and laboratory findings in distinguishing acute appendicitis and lymphoid hyperplasia. Ann Surg Treat Res 2022; 103:306-311. [DOI: 10.4174/astr.2022.103.5.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/22/2022] [Accepted: 09/01/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Keziban Ucar Karabulut
- Department of Emergency Medicine, Konya Training and Research Hospital, Baskent University, Konya, Turkey
| | - Hilal Erinanc
- Department of Pathology, Konya Training and Research Hospital, Baskent University, Konya, Turkey
| | - Aynur Yonar
- Department of Statistics, Faculty of Science, Selcuk University, Konya, Turkey
| | - Alpaslan Kisinma
- Department of Emergency Medicine, Konya Training and Research Hospital, Baskent University, Konya, Turkey
| | - Yildiz Ucar
- Department of Pulmonary Disease, Konya Private Meram Akademi Hospital, Konya, Turkey
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Clinical Significance of Variable Histomorphologic Findings Related to Mucosal Inflammation in Negative Appendectomy. J Clin Med 2021; 10:jcm10174030. [PMID: 34501478 PMCID: PMC8432450 DOI: 10.3390/jcm10174030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/27/2021] [Accepted: 09/02/2021] [Indexed: 11/29/2022] Open
Abstract
The aim of the study was to investigate the clinical significance of various histomorphologic findings related to mucosal inflammation in negative appendectomy. We reviewed histopathologic findings of 118 negative appendectomies and correlated them with the appendicitis inflammatory response (AIR) score and appendiceal diameter. Among 118 patients with negative appendectomy, 94 (80%), 73 (78%) and 89 (75%) patients displayed mucosal inflammation, high neutrophil score (neutrophil count ≥10/5 high power field and surface epithelial flattening, respectively. Out of 118 patients with negative appendectomy, mucosal inflammation, high neutrophil score and surface epithelial flattening were associated with higher risk group according to the appendicitis inflammatory response (AIR) score (p < 0.05, respectively). In addition, mucosal inflammation, high neutrophil score and surface epithelial flattening were frequently detected in 118 negative appendectomies, compared with 24 incidental appendectomies (p < 0.05, respectively). In an analysis of 77 negative appendectomy patients with appendiceal diameter data available, increased appendiceal diameter was positively correlated with luminal inflammation, high neutrophil score and surface epithelial flattening (p < 0.05, respectively). In conclusion, mucosal inflammation, high neutrophil score and surface epithelial flattening in negative appendectomy may be relevant to patients’ signs and symptoms, especially in cases with no other cause of the abdominal pain.
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Bedel C, Korkut M, Selvi F, Zortuk Ö. The Bedel Score: Suggesting a New Scoring System to Avoid Negative Appendectomy. JOURNAL OF MEDICAL AND SURGICAL RESEARCH 2021. [DOI: 10.46327/msrjg.1.000000000000198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Introduction: Scoring systems are still valuable and valid for differential diagnosis of acute appendicitis (AA). Bedel Score is a new diagnostic tool with 7 parameters that can be easily applied. The aim of this study is to determine the diagnostic performance of the Bedel score in AA and compare it with the Alvarado score. Methods: Our study consisted of 95 patients as a prospective cohort who were admitted to our emergency department due to abdominal pain and were hospitalized with a preliminary diagnosis of AA. Bedel and Alvarado scores were calculated. The patients were categorized into two groups (positive and negative appendectomy) according to their histopathological diagnosis. Results: The study population consisted of 65 (68.4%) male and 30 (31.6%) female patients. The mean age of the patients was 34 (18-87) years. 81 (85.3%) of the patients had histopathologically confirmed AA. Median Alvarado score was significantly higher in patients with positive AA than those with negative AA (7 (range: 3-10) vs. 5 (range 3-7), p<0.001, respectively). Median Bedel score of positive AA patients were also significantly higher than those with negative AA (9 (range: 6-10) vs. 5 (range 2-8) p<0.001, respectively) In separating acute appendicitis from negative exploration, the threshold of the Alvarado score is 63% sensitivity for ?7, 85.7% specificity; The Bedel score had 80.2% sensitivity and 92.9% specificity for the threshold value ?7. Conclusion: Bedel score is fast, simple, easy to learn and apply, as well as an effective and practical scoring system with only 7 parameters.
Keywords: Acute appendicitis, Alvarado score, New score, Negative appendectomy
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Sangüesa-Nebot C, Llorens-Salvador R. Ecografía intestinal en pediatría. RADIOLOGIA 2021; 63:291-304. [DOI: 10.1016/j.rx.2020.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/29/2020] [Accepted: 08/24/2020] [Indexed: 12/15/2022]
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9
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Sangüesa-Nebot C, Llorens-Salvador R. Intestinal ultrasound in pediatrics. RADIOLOGIA 2021. [DOI: 10.1016/j.rxeng.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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10
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Penticuff R, Jeffrey RB, Olcott EW. Hyperechoic Periappendiceal Fat: Evaluation of Criteria for Improving Specificity in the Sonographic Diagnosis of Appendicitis in Pediatric Patients. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:285-296. [PMID: 32697409 DOI: 10.1002/jum.15399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 05/28/2020] [Accepted: 06/04/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To test the hypothesis that abutting and encasing types of hyperechoic periappendiceal fat are specific sonographic indicators of appendicitis in pediatric patients, including individuals with maximum outer diameters (MODs) of 6 to 8 mm in whom diagnosis by the MOD alone is known to be equivocal. METHODS Appendiceal sonograms of 271 consecutive pediatric patients were retrospectively evaluated for hyperechoic periappendiceal fat (globular, ≥1.0 cm; categorized as type 0, none; type 1, "abutting," encompassing <180° of the appendiceal circumference; or type 2, "encasing," encompassing 180° or more of the appendiceal circumference) and the MOD. Histopathologic and medical records constituted reference standards. Statistical methods included the binomial distribution, logistic regression, a receiver operating characteristic analysis, and the exact McNemar test. RESULTS All patients with hyperechoic fat and 105 of 107 patients with appendicitis had MODs of 6 mm or greater. The MOD and fat types 1 and 2 each were significantly associated with appendicitis in the univariable regression. The MOD and fat type 1 were independently associated with appendicitis in multivariable regression (odds ratio, 24.97; P = .034; and odds ratio, 5.35; P < .001, respectively). Specificities of an MOD of 6 to 8 mm and an MOD of 6 mm or greater alone were 89.0% (95% confidence interval, 83.2%-93.4%); these increased to 100.0% each (95% confidence interval, 97.8%-100.0%; P < .001) when combined with fat types 1, 2, and either 1 or 2 as diagnostic criteria, with positive predictive values of 100.0%. CONCLUSIONS Types 1 and 2 periappendiceal fat are specific indicators of appendicitis, and both improve specificity compared to the MOD. Importantly, they add specificity in diagnosing appendicitis in patients with diagnostically equivocal MODs of 6 to 8 mm.
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Affiliation(s)
- Ryan Penticuff
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - R Brooke Jeffrey
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Eric W Olcott
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
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Reply to "Comment on the Correlation between Complete Blood Count Parameters and Appendix Diameter for the Diagnosis of Acute Appendicitis". Healthcare (Basel) 2020; 8:healthcare8040462. [PMID: 33167461 PMCID: PMC7711664 DOI: 10.3390/healthcare8040462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/08/2020] [Accepted: 10/22/2020] [Indexed: 11/21/2022] Open
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The Borderline-Size Appendix: Grayscale, Color Doppler, and Spectral Doppler Findings That Improve Specificity for the Sonographic Diagnosis of Acute Appendicitis. Ultrasound Q 2020; 36:314-320. [PMID: 33136933 DOI: 10.1097/ruq.0000000000000536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Diagnostic criteria for acute appendicitis using graded compression sonography have been well established based on the maximum outer diameter (MOD) of the appendix, with MOD values of <6 mm nearly always indicating normal appendices and MOD values of >8 mm nearly always indicating appendicitis. However, the "borderline-size" appendix, meaning one whose MOD lies between these ranges (ie, an appendix with MOD of 6-8 mm), presents a diagnostic dilemma because appendices in this size range are neither clearly normal nor abnormal when diagnosis is based on the MOD alone; accordingly, such borderline MOD values are diagnostically equivocal, and sonographic diagnosis must rely on sonographic findings other than the MOD. The goal of this review was to examine the additional sonographic findings that can add specificity and help enable an accurate diagnosis to be made in patients with borderline-size appendices.
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Martínez Pérez MJ, Blanc García E, Merino Bonilla JA. Bowel ultrasound: examination techniques and normal and pathologic patterns. RADIOLOGIA 2020; 62:517-527. [PMID: 33127091 DOI: 10.1016/j.rx.2020.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 08/31/2020] [Accepted: 09/17/2020] [Indexed: 12/11/2022]
Abstract
Ultrasound is being increasingly used to study the digestive tract because it has certain advantages over other techniques such as endoscopy, CT enterography, and MR enterography. Ultrasound can be used to evaluate the bowel wall and the elements that surround it without the need for contrast agents; its ability to evaluate the elasticity and peristalsis of these structures is increasing interest in its use. This article describes the techniques and modalities of bowel ultrasound, as well as the normal features of the bowel wall and contiguous structures. It uses a practical approach to review the main pathological findings and their interpretation, and the different patterns of presentation, which will help orient the diagnosis.
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Affiliation(s)
- M J Martínez Pérez
- Servicio de Radiodiagnóstico, Hospital Universitario Doctor Peset, Valencia, España.
| | - E Blanc García
- Servicio de Radiodiagnóstico, Hospital Universitario Doctor Peset, Valencia, España
| | - J A Merino Bonilla
- Servicio de Radiodiagnóstico, Hospital Santiago Apóstol, Miranda de Ebro, Burgos, España
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Donlon NE, Kelly ME, Sheppard A, Davern M, Nugent TS, Boland PA, Corless K, Khan W, Khan I, Waldron R, Barry K. Negative appendicectomy rates as a quality measure in a regional surgical unit: a retrospective review. Ir J Med Sci 2020; 190:755-761. [PMID: 32915371 DOI: 10.1007/s11845-020-02360-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 08/31/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Historically, high negative appendicectomy rates (NAR) were acceptable to offset the risks of perforation, previously exceeding 20%. With improved imaging and clinical scoring algorithms, there is growing demand for lower negative appendicectomy rates. The objectives were to (1) establish the NAR in our institution and (2) correlate clinical parameters and imaging modalities with histological findings. METHODS Patients undergoing an appendicectomy between January 2012 and June 2018 were identified using a prospectively maintained pathology database. Histology findings were cross referenced against our radiology system, and anonymised data was collected for gender, age, WCC, Neutrophil and CRP level. RESULTS One thousand one hundred fifty-three patients met the inclusion criteria. Fifty-three percent were males (n = 610), with 81% (n = 933) of histology reports classified as appendicitis. Sixty patients had a histologically normal appendix equating to a 5.2% NAR. If lymphoid hyperplasia, fibrosis and atrophy are included, it equates to a NAR of 14.57%. (p < 0.0001). Sixty-six percent of patients had no pre-operative imaging. CT imaging demonstrated a higher sensitivity (93.33%) and positive predictive value (99.60%) compared to ultrasonography. WCC and CRP are statistically significant in predicting appendicitis (p < 0.0001). CONCLUSION There is no consensus on defining a negative appendicectomy or for imaging modality utilisation. CT imaging is the most sensitive and should be used in cases of diagnostic uncertainty. A standardised algorithm regarding the workup of patients with RIF pain along with a consensus on the use of imaging will further reduce negative appendicectomy rates.
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Affiliation(s)
- Noel E Donlon
- Department of General Surgery, Mayo University Hospital, Castlebar, Mayo, Ireland. .,Department of General Surgery, St. James' Hospital, Dublin, 8, Ireland.
| | - Michael E Kelly
- Department of General Surgery, Mayo University Hospital, Castlebar, Mayo, Ireland.,Department of General Surgery, St. James' Hospital, Dublin, 8, Ireland
| | - Andrew Sheppard
- Department of General Surgery, St. James' Hospital, Dublin, 8, Ireland
| | - Maria Davern
- Department of General Surgery, St. James' Hospital, Dublin, 8, Ireland
| | - Tim S Nugent
- Department of General Surgery, Mayo University Hospital, Castlebar, Mayo, Ireland.,Department of General Surgery, St. James' Hospital, Dublin, 8, Ireland
| | - Patrick A Boland
- Department of General Surgery, Mayo University Hospital, Castlebar, Mayo, Ireland
| | - Kevin Corless
- Department of General Surgery, Mayo University Hospital, Castlebar, Mayo, Ireland
| | - Waqar Khan
- Department of General Surgery, Mayo University Hospital, Castlebar, Mayo, Ireland
| | - Iqbal Khan
- Department of General Surgery, Mayo University Hospital, Castlebar, Mayo, Ireland
| | - Ronan Waldron
- Department of General Surgery, Mayo University Hospital, Castlebar, Mayo, Ireland
| | - Kevin Barry
- Department of General Surgery, Mayo University Hospital, Castlebar, Mayo, Ireland.,Discipline of Surgery, National University of Ireland, Galway, Ireland
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Meister M, Alharthi O, Kim JS, Son JK. Pediatric emergency gastrointestinal ultrasonography: pearls & pitfalls. Clin Imaging 2020; 64:103-118. [PMID: 32438254 DOI: 10.1016/j.clinimag.2020.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/16/2020] [Accepted: 03/11/2020] [Indexed: 01/08/2023]
Abstract
Ultrasonography is an essential tool in pediatric imaging, particularly in the emergency setting. Although ultrasound is often the favored initial modality for abdominal imaging in children, it is highly operator-dependent and therefore prone to misinterpretation which can lead to false positive or negative exams, or even incorrect diagnoses. Conditions discussed in this series include ileocolic intussusception, hypertrophic pyloric stenosis, appendicitis, and ingested foreign bodies. We will review diagnostic criteria, highlight crucial findings, and illustrate commonly-encountered difficulties and mimics.
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Affiliation(s)
- Moshe Meister
- University of Maryland Medical Center, Department of Diagnostic Radiology and Nuclear Medicine, 22 South Greene Street, Baltimore, MD 21201, United States.
| | - Omar Alharthi
- University of Maryland Medical Center, Department of Diagnostic Radiology and Nuclear Medicine, 22 South Greene Street, Baltimore, MD 21201, United States; Taibah University, College of Medicine - Department of Radiology, Universities Road, Medina, 42353, Saudi Arabia
| | - Jane S Kim
- University of Maryland Medical Center, Department of Diagnostic Radiology and Nuclear Medicine, 22 South Greene Street, Baltimore, MD 21201, United States
| | - Jennifer K Son
- University of Maryland Medical Center, Department of Diagnostic Radiology and Nuclear Medicine, 22 South Greene Street, Baltimore, MD 21201, United States
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Revzin MV, Moshiri M, Bokhari J, Pellerito JS, Menias C. Sonographic assessment of infectious diseases of the gastrointestinal tract: from scanning to diagnosis. Abdom Radiol (NY) 2020; 45:261-292. [PMID: 31960117 DOI: 10.1007/s00261-019-02358-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Sonography of the gastrointestinal (GI) tract is a practical, safe, inexpensive, and reproducible diagnostic tool for the evaluation, diagnosis, and follow-up of infectious bowel disease. The modality is rapidly gaining prominence among clinicians on a global scale. In the United States, however, ultrasound of the bowel remains underutilized primarily due to insufficient experience among radiologists and sonographers in performing sonographic bowel assessment. This lack of experience and knowledge results in misinterpretations, missed diagnoses, and underutilization of this modality in patients with acute abdomen, with the majority of GI pathology on sonography discovered incidentally. OBJECTIVES This article aims to demonstrate the characteristic sonographic findings associated with GI infectious processes as well as provide dedicated ultrasound protocols for evaluation of the GI tract. CONCLUSION This article serves a twofold purpose, raising awareness of the utility of this imaging modality within the radiology community and also providing practical teaching points for sonographic evaluation of infectious disorders of the GI tract.
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Affiliation(s)
- Margarita V Revzin
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar Street, PO Box 208042, Room TE-2, New Haven, CT, 06520, USA.
| | - Mariam Moshiri
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
| | - Jamal Bokhari
- Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar Street, PO Box 208042, Room TE-2, New Haven, CT, 06520, USA
| | - John S Pellerito
- Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, 300 Community Drive, Manhasset, NY, 11030, USA
| | - Christine Menias
- Radiology, Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
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Whittle C, Pérez L, Cortes M, Switt M, Aguirre J, Castro A. Appendicular Lymphoid Hyperplasia in the Differential Diagnosis of Acute Appendicitis: Sonographic Findings. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2020. [DOI: 10.1177/8756479319878235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: To describe sonographic findings of appendicular lymphoid hyperplasia (ALH) and to report demographic data of patients with ALH operated for acute appendicitis (AA). Materials and Methods: In a retrospective study, 694 biopsies of consecutive AA surgeries with previous ultrasonography (US) were reviewed, after selecting the ALH cases. Results: Twenty-five ALH cases were proved histologically (3.8% of appendectomies). The mean age was 13 years, with 84% under 20 years. US findings showed increased appendiceal diameter (average 7 mm) (82%), hypoechogenic pseudonodular mucosal thickening (50%), concentric parietal thickening (13%), and periappendiceal inflammatory changes (18%). In four cases, a normal appendix was noted on US, with two associated with intestinal intussusceptions. Conclusion: ALH is a benign entity most frequent in children that can predispose to AA. Both pathologies can increase the appendiceal diameter. In the pediatric group, ALH could be considered when hypoechogenic pseudonodular appendicular mucosal thickening in the absence of periappendiceal inflammatory changes occurs.
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Affiliation(s)
- Carolina Whittle
- Radiology Department, Clínica Alemana, Facultad de Medicina Clínica Alemana – Universidad del Desarrollo, Santiago, Chile
| | - Lizbet Pérez
- Radiology Department, Clínica Alemana, Facultad de Medicina Clínica Alemana – Universidad del Desarrollo, Santiago, Chile
| | - Marcela Cortes
- Radiology Department, Clínica Alemana, Facultad de Medicina Clínica Alemana – Universidad del Desarrollo, Santiago, Chile
| | - Margarita Switt
- Radiology Department, Clínica Alemana, Facultad de Medicina Clínica Alemana – Universidad del Desarrollo, Santiago, Chile
| | - Javiera Aguirre
- Radiology Department, Clínica Alemana, Facultad de Medicina Clínica Alemana – Universidad del Desarrollo, Santiago, Chile
| | - Alex Castro
- Pathology Department, Clínica Alemana, Facultad de Medicina Clínica Alemana – Universidad del Desarrollo, Santiago, Chile
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Aydin S, Tek C, Ergun E, Kazci O, Kosar PN. Acute Appendicitis or Lymphoid Hyperplasia: How to Distinguish More Safely? Can Assoc Radiol J 2019; 70:354-360. [PMID: 31500858 DOI: 10.1016/j.carj.2018.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 07/05/2018] [Accepted: 09/20/2018] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Lymphoid hyperplasia can be an important mimicker of acute appendicitis by creating a non-compressible appendix more than 6 mm in diameter. The aim of this study was to evaluate methods of distinguishing lymphoid hyperplasia and appendicitis on the basis of sonography, lamina propria thickness, and Alvarado scoring. METHODS This retrospective study included 259 patients (142 appendicitis, 117 lymphoid hyperplasia). The US (ultrasound) reports of the patients were reviewed and the maximum diameter of the appendix, the presence or absence of increased echogenicity of the surrounding pericaecal fat, local fluid collection, the presence of reactive lymph nodes in the periappendiceal area, and mural hyperemia within the appendix were recorded. RESULTS The use of additional sonographic criteria, lamina propria thickness (≤1 mm is indicative for appendicitis), or Alvarado scoring (>6 mm is indicative for appendicitis) provided a true-positive diagnosis for acute appendicitis. CONCLUSION The presence of local fluid collection in the periappendiceal area and a lamina propria thickness ≤ 1 mm are the most successful parameters for distinguishing appendicitis from lymphoid hyperplasia.
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Affiliation(s)
- Sonay Aydin
- Ankara Training and Research Hospital, Department of Radiology, Ankara, Turkey.
| | - Cihat Tek
- Ankara Training and Research Hospital, Department of Radiology, Ankara, Turkey
| | - Elif Ergun
- Ankara Training and Research Hospital, Department of Radiology, Ankara, Turkey
| | - Omer Kazci
- Ankara Training and Research Hospital, Department of Radiology, Ankara, Turkey
| | - Pinar Nercis Kosar
- Ankara Training and Research Hospital, Department of Radiology, Ankara, Turkey
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20
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Kuhn KJ, Brooke Jeffrey R, Olcott EW. Reply by Authors. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:121. [PMID: 30730560 DOI: 10.1002/jcu.22706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 01/22/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Karin J Kuhn
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - R Brooke Jeffrey
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Eric W Olcott
- Department of Radiology, Stanford University School of Medicine, Stanford, California
- Department of Radiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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21
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Kuhn KJ, Brooke Jeffrey R, Olcott EW. Luminal obstruction in uncomplicated appendicitis: Detection with sonography and potential clinical implications. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:113-119. [PMID: 30350372 DOI: 10.1002/jcu.22655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 08/29/2018] [Accepted: 09/27/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE To determine the frequency of luminal obstruction on appendiceal graded compression sonography (US) in patients with uncomplicated appendicitis and test the hypothesis that this frequency is similar to the failure rates of primary antibiotic therapy for uncomplicated appendicitis when treatment selection is based on CT findings. METHODS Sonograms of 150 consecutive patients with appendicitis diagnosed on ultrasound (US) and proven histopathologically were retrospectively evaluated; 114 (76.0%) had uncomplicated appendicitis, that is, appendicitis without gangrene or perforation, and were evaluated for appendicolithiasis and lymphoid hyperplasia using previously published sonographic criteria, and for luminal obstruction. RESULTS Of the 114 patients with uncomplicated appendicitis, US demonstrated no luminal obstruction in 74 (64.9%) and luminal obstruction in 40 (35.1%, P = .018), the latter including 16 (40.0%) with lymphoid hyperplasia and 24 (60.0%, P = .074) with appendicolithiasis. CONCLUSIONS US demonstrated luminal obstruction in 35.1% of patients with uncomplicated appendicitis, similar to the published failure rates of antibiotic therapy when treatment selection is based on CT. This confirms the hypothesis, supporting the possibility that undiagnosed luminal obstruction may account for treatment failures when patients are selected by CT for primary antibiotic therapy, and suggests a role for US in selecting patients without luminal obstruction for antibiotic therapy.
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Affiliation(s)
- Karin J Kuhn
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - R Brooke Jeffrey
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Eric W Olcott
- Department of Radiology, Stanford University School of Medicine, Stanford, California
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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22
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Hollerweger A. Commentary on the article "Luminal obstruction in uncomplicated appendicitis: detection with sonography and potential clinical implications". JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:120. [PMID: 30730558 DOI: 10.1002/jcu.22707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 11/17/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Alois Hollerweger
- Department of Radiology, Hospital Barmherzige Brüder, Salzburg, Austria
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23
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Tal Tamir H, Ben-Mordechay D, Ben-Shlush A, Raviv-Zilka L, Soudack M. Increased Renal Echogenicity in Children With Appendicitis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1403-1409. [PMID: 29159839 DOI: 10.1002/jum.14480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 08/22/2017] [Accepted: 08/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Ultrasound (US) is an important modality for the detection of acute appendicitis in children but has limited sensitivity and specificity. Therefore, additional US findings may contribute to the diagnosis. In our experience, children with acute appendicitis often have increased renal cortical echogenicity on US imaging. The purpose of this study was to examine the association of increased renal cortical echogenicity with appendicitis. METHODS This study included 240 consecutive pediatric patients with no renal or liver disease who underwent US examinations for suspected appendicitis between February 2014 and January 2016. Ultrasound images of the liver and right kidney were retrospectively reviewed, and the echogenicity of the renal cortex was classified as less than the liver, equal to the liver, or greater than the liver. RESULTS The renal cortex was abnormally hyperechoic in 38 (50%) of all of the patients who had appendicitis according to US (P < .001) and in 47% of patients who underwent appendectomy (P = .002). Overall, 36% of patients with increased renal cortical echogenicity had a diagnosis of appendicitis. After correction for variables, patients with renal hyperechogenicity had a 2.5 times chance of appendicitis (odds ratio, 2.5). CONCLUSIONS There is a statistically significant association between increased renal cortical echogenicity and appendicitis. In the absence of hepatic or renal disease, this finding may increase the accuracy of the US diagnosis of appendicitis. Increased renal cortical echogenicity may be added to the list of US findings accompanying acute appendicitis in children.
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Affiliation(s)
- Hila Tal Tamir
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Aviva Ben-Shlush
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
| | - Lisa Raviv-Zilka
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
| | - Michalle Soudack
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
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24
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Reddan T, Corness J, Harden F, Mengersen K. Improving the value of ultrasound in children with suspected appendicitis: a prospective study integrating secondary sonographic signs. Ultrasonography 2018; 38:67-75. [PMID: 30016853 PMCID: PMC6323308 DOI: 10.14366/usg.17062] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 05/07/2018] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The purpose of this study was to determine whether the awareness and inclusion of secondary sonographic signs of appendicitis, in combination with a structured evaluation as part of engagement and training for sonographers, improved appendix visualization rates and reduced equivocal findings in children with suspected acute appendicitis. METHODS This was a prospective study of 230 children at a tertiary children's hospital in Australia referred for an ultrasound examination of suspected appendicitis. The ultrasound findings, radiology reports, histology, clinical results, and follow-up were collated. Secondary signs were used as an additional assessment of the likelihood of disease where possible, even in the absence of an identified appendix. RESULTS The implementation of a structured evaluation as part of sonographer engagement and training resulted in a 28% improvement in appendix visualization (68.7%) compared with a prior retrospective study in a similar population (40.7%). The diagnostic accuracy was 91.7%, with likelihood ratios suggesting a meaningful influence of the pre-test probability of appendicitis in children studied (positive likelihood ratio, 11.22; negative likelihood ratio, 0.09.). Only 7.8% of the findings were equivocal. A binary 6-mm diameter cut-off did not account for equivocal cases, particularly lymphoid hyperplasia. CONCLUSION Engagement of sonographers performing pediatric appendiceal ultrasound through training in the scanning technique and awareness of secondary signs significantly improved the visualization rate and provided more meaningful findings to referrers.
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Affiliation(s)
- Tristan Reddan
- Medical Imaging and Nuclear Medicine, Lady Cilento Children's Hospital, South Brisbane, Australia.,Science and Engineering Faculty, Queensland University of Technology, Brisbane, Australia
| | - Jonathan Corness
- Medical Imaging and Nuclear Medicine, Lady Cilento Children's Hospital, South Brisbane, Australia
| | | | - Kerrie Mengersen
- Science and Engineering Faculty, Queensland University of Technology, Brisbane, Australia
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25
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Kwon LM, Lee K, Min SK, Ahn SM, Ha HI, Kim MJ. Ultrasound features of secondary appendicitis in pediatric patients. Ultrasonography 2017; 37:233-243. [PMID: 29141286 PMCID: PMC6044217 DOI: 10.14366/usg.17029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 08/25/2017] [Indexed: 12/28/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the ultrasonographic findings of secondary appendicitis (SA) and to discuss the differential findings compared with primary appendicitis. Methods In this study, we analyzed the ultrasonographic findings of 94 patients under 15 years old of age treated at our institution from May 2005 to May 2014 who had bowel inflammation and an inflamed appendix with a maximal outer diameter >6 mm that improved with nonsurgical treatment (the SA group). Ninety-nine patients with pathologically proven acute appendicitis (the primary appendicitis [PA] group) from June 2013 to May 2014 and 44 patients with pathologically negative appendectomy results from May 2005 to May 2014 were also included to compare the ultrasonographic features of these conditions. A retrospective review of the ultrasonographic findings was performed by two radiologists. The clinical and laboratory findings were also reviewed. The results were statically analyzed using analysis of variance, the Pearson chi-square test, and the two-tailed Fisher exact test. Results Compared with PA, cases of SA had a smaller diameter (9.8 mm vs. 6.6 mm, P<0.001), and were less likely to show periappendiceal fat inflammation (98% vs. 6%, P<0.001) or an appendicolith (34% vs. 11%, P<0.001). SA showed mural hyperemia on color Doppler ultrasonography as frequently as PA (P=0.887). Conclusion The ultrasonographic features of SA included an increased diameter compared to a healthy appendix and the same level of hyperemia as in PA. However, the diameter was commonly in the equivocal range (mean diameter, 6.6 mm), and periappendiceal fat inflammation was rarely present in SA.
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Affiliation(s)
- Lyo Min Kwon
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kwanseop Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Soo Kee Min
- Department of Pathology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Soo Min Ahn
- Department of Pediatric Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Hong Il Ha
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Min-Jeong Kim
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Korea
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26
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Gongidi P, Bellah RD. Ultrasound of the pediatric appendix. Pediatr Radiol 2017; 47:1091-1100. [PMID: 28779198 DOI: 10.1007/s00247-017-3928-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 04/21/2017] [Accepted: 06/09/2017] [Indexed: 11/29/2022]
Abstract
Appendicitis is the most common pediatric surgical emergency. Ultrasound (US) receives the highest appropriate rating scale in children with right lower quadrant pain suspected to have appendicitis. The US exam of the appendix has improved since Puylaert pioneered the technique of graded compression in 1986. In this article, we review ultrasonography of the pediatric appendix as it pertains to the normal appendix, acute appendicitis and the different sonographic manifestations. We also briefly describe technical optimization of image acquisition, common pitfalls and differential diagnoses.
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Affiliation(s)
- Preetam Gongidi
- Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 3401 Civil Center Boulevard, Room #3W47, Main Building, Philadelphia, PA, 19104, USA.
| | - Richard D Bellah
- Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 3401 Civil Center Boulevard, Room #3W47, Main Building, Philadelphia, PA, 19104, USA.,Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 3401 Civil Center Boulevard, Room #3W12, Main Building, Philadelphia, PA, 19104, USA
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