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CT Evaluation of Appendicitis

  • F. Monetti
  • A. Bhangu
  • S. Di Saverio
  • M. Stellino
  • P. E. Orlandi
  • M. Imbriani
Chapter
Part of the Hot Topics in Acute Care Surgery and Trauma book series (HTACST)

Abstract

Appendicitis is the most common cause of acute abdominal pain requiring surgery. An early diagnosis is crucial to the success of surgical therapy and to avoid complications.

Computed tomography (CT) due to the high accuracy has become the gold standard for the diagnosis of acute appendicitis.

This chapter reviews current CT imaging techniques, signs, and differential diagnosis in patients with clinically suspected appendicitis.

References

  1. 1.
    Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet. 2015;386(10000):1278–87. doi: 10.1016/S0140-6736(15)00275-5.CrossRefGoogle Scholar
  2. 2.
    Di Saverio S, Birindelli A, Kelly MD, Catena F, Weber DG, Sartelli M, Sugrue M, De Moya M, Gomes CA, Bhangu A, Agresta F, Moore EE, Soreide K, Griffiths E, De Castro S, Kashuk J, Kluger Y, Leppaniemi A, Ansaloni L, Andersson M, Coccolini F, Coimbra R, Gurusamy KS, Campanile FC, Biffl W, Chiara O, Moore F, Peitzman AB, Fraga GP, Costa D, Maier RV, Rizoli S, Balogh ZJ, Bendinelli C, Cirocchi R, Tonini V, Piccinini A, Tugnoli G, Jovine E, Persiani R, Biondi A, Scalea T, Stahel P, Ivatury R, Velmahos G, Andersson R. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg. 2016;11:34. doi: 10.1186/s13017-016-0090-5.
  3. 3.
    Di Saverio S, Sibilio A, Giorgini E, Biscardi A, Villani S, Coccolini F, Smerieri N, Pisano M, Ansaloni L, Sartelli M, Catena F, Tugnoli G. The NOTA Study (Non Operative Treatment for Acute Appendicitis): prospective study on the efficacy and safety of antibiotics (amoxicillin and clavulanic acid) for treating patients with right lower quadrant abdominal pain and long-term follow-up of conservatively treated suspected appendicitis. Ann Surg. 2014;260(1):109–17. doi: 10.1097/SLA.0000000000000560.CrossRefPubMedGoogle Scholar
  4. 4.
    Di Saverio S, Mandrioli M, Sibilio A, Smerieri N, Lombardi R, Catena F, Ansaloni L, Tugnoli G, Masetti M, Jovine E. A cost-effective technique for laparoscopic appendectomy: outcomes and costs of a case-control prospective single-operator study of 112 unselected consecutive cases of complicated acute appendicitis. J Am Coll Surg. 2014;218(3):e51–65. doi: 10.1016/j.jamcollsurg.2013.12.003. Epub 2013 Dec 19.CrossRefPubMedGoogle Scholar

Bibliography

  1. 5.
    Whitley S, et al. The appendix on CT. Clin Radiol. 2009;64(2):190–9.CrossRefPubMedGoogle Scholar
  2. 6.
    Karul M, Berliner C, Keller S, Yamamura J, Tsui TY. Imaging of appendicitis in adults. Rofo. 2014;186(6):551–8.CrossRefPubMedGoogle Scholar
  3. 7.
    Crownover BK, Bepko JL. Appropriate and safe use of diagnostic imaging. Am Fam Physician. 2013;87(7):494–501. PMID: 23547591.PubMedGoogle Scholar
  4. 8.
    Sartelli M, Viale P, Catena F, Ansaloni L, Moore E, Malangoni M, Moore FA, Velmahos G, Coimbra R, Ivatury R, Peitzman A, Koike K, Leppaniemi A, Biffl W, Burlew CC, Balogh ZJ, Boffard K, Bendinelli C, Gupta S, Kluger Y, Agresta F, Di Saverio S, Wani I, Escalona A, Ordonez C, Fraga GP, Junior GA, Bala M, Cui Y, Marwah S, Sakakushev B, Kong V, Naidoo N, Ahmed A, Abbas A, Guercioni G, Vettoretto N, Díaz-Nieto R, Gerych I, Tranà C, Faro MP, Yuan KC, Kok KY, Mefire AC, Lee JG, Hong SK, Ghnnam W, Siribumrungwong B, Sato N, Murata K, Irahara T, Coccolini F, Segovia Lohse HA, Verni A, Shoko T. WSES guidelines for management of intra-abdominal infections. World J Emerg Surg. 2013;8(1):3. doi: 10.1186/1749–7922–8-3. PMID: 23294512; PMCID: PMC3545734.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 9.
    Furukawa A, et al. Gastrointestinal tract perforation: CT diagnosis of presence, site, and cause. Abdom Imaging. 2005;30(5):524–34.CrossRefPubMedGoogle Scholar
  6. 10.
    Liang MK, Lo HG, Marks JL. Stump appendicitis: a comprehensive review of literature. Am Surg. 2006;72(2):162–6.PubMedGoogle Scholar
  7. 11.
    Brown MA. Imaging acute appendicitis. Semin Ultrasound CT MR. 2008;29(5):293–307.CrossRefPubMedGoogle Scholar
  8. 12.
    Millet I, et al. Infection of the right iliac fossa. Diagn Interv Imaging. 2012;93(6):441–52.CrossRefPubMedGoogle Scholar
  9. 13.
    Birnbaum BA, Wilson SR. Appendicitis at the millennium 1. Radiology. 2000;215(2):337–48.CrossRefPubMedGoogle Scholar
  10. 14.
    Wong KKY, Cheung TWY, Tam PKH. Diagnosing acute appendicitis: are we overusing radiologic investigations? J Pediatr Surg. 2008;43(12):2239–41.CrossRefPubMedGoogle Scholar
  11. 15.
    Bhatt CJ, et al. Multidetector computed tomography in large bowel lesions—a study of 100 cases. Indian J Surg. 2011;73(5):352–8.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 16.
    Atema JJ, et al. Comparison of imaging strategies with conditional versus immediate contrast-enhanced computed tomography in patients with clinical suspicion of acute appendicitis. Eur Radiol. 2015;25(8):2445–52.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 17.
    Park G, et al. Stratified computed tomography findings improve diagnostic accuracy for appendicitis. World J Gastroenterol. 2014;20(38):13942–9.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 18.
    Drake FT, Flum DR. Improvement in the diagnosis of appendicitis. Adv Surg. 2013;47:299.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 19.
    Doria AS. Optimizing the role of imaging in appendicitis. Pediatr Radiol. 2009;39(2):144–8.CrossRefGoogle Scholar
  16. 20.
    Petroianu A. Diagnosis of acute appendicitis. Int J Surg. 2012;10(3):115–9.CrossRefPubMedGoogle Scholar
  17. 21.
    Rhea JT, et al. The status of appendiceal CT in an urban medical center 5 years after its introduction: experience with 753 patients. Am J Roentgenol. 2005;184(6):1802–8.CrossRefGoogle Scholar
  18. 22.
    Moteki T, Horikoshi H. New CT criterion for acute appendicitis: maximum depth of intraluminal appendiceal fluid. Am J Roentgenol. 2007;188(5):1313–9.CrossRefGoogle Scholar
  19. 23.
    Smith MP, et al. ACR appropriateness criteria® right lower quadrant pain—suspected appendicitis. Ultrasound Q. 2015;31(2):85–91.CrossRefPubMedGoogle Scholar
  20. 24.
    Birchard KR, Brown MA, Hyslop WB, Firat Z, Semelka RC. MRI of acute abdominal and pelvic pain in pregnant patients. Am J Roentgenol. 2005;184:452–8.CrossRefGoogle Scholar
  21. 25.
    Cobben LP, Groot I, Haans L, Blickman JG, Puylaert J. MRI for clinically suspected appendicitis during pregnancy. Am J Roentgenol. 2004;183:671–5.CrossRefGoogle Scholar
  22. 26.
    Kessler N, Cyteval C, Gallix B, Lesnik A, Blayac PM, Pujol J, Bruel JM, Taourel P. Appendicitis: evaluation of sensitivity, specificity, and predictive values of US, Doppler US, and laboratory findings. Radiology. 2004;230:472–8.CrossRefPubMedGoogle Scholar
  23. 27.
    Moteki T, Horikoshi H. New CT criterion for acute appendicitis: maximum depth of intraluminal appendiceal fluid. Am J Roentgenol. 2007;188:1313–9.CrossRefGoogle Scholar
  24. 28.
    Nitta N, Takahashi M, Furukawa A, Murata K, Mori M, Fukushima M. MR imaging of the normal appendix and acute appendicitis. J Magn Reson Imaging. 2005;21:156–65.CrossRefPubMedGoogle Scholar
  25. 29.
    Yu J, Fulcher AS, Turner MA, Halvorsen RA. Helical CT evaluation of acute right lower quadrant pain: part II, uncommon mimics of appendicitis. Am J Roentgenol. 2005;184:1143–9.CrossRefGoogle Scholar
  26. 30.
    Weyant MF, Sr E, Maluccio MA, Barie PS. Is imaging necessary for the diagnosis of acute appendicitis? Adv Surg. 2003;37:327–45.PubMedGoogle Scholar
  27. 31.
    Otero HJ, Ondategui-Parra S, Erturk SM, Ochoa RE, Gonzalez-Beicos A, Ros PR. Imaging utilization in the management of appendicitis and its impact on hospital charges. Emerg Radiol. 2007;15:23–8.CrossRefPubMedGoogle Scholar
  28. 32.
    Pedrosa I, Levine D, Eyvazzadeh AD, Siewert B, Ngo L, Rofsky NM. MR imaging evaluation of acute appendicitis in pregnancy. Radiology. 2006;238:891–9.CrossRefPubMedGoogle Scholar
  29. 33.
    Tamburrini S, Brunetti A, Brown M, Sirlin CB, Casola G. CT appearance of the normal appendix in adults. Eur Radiol. 2005;15:2096–103.CrossRefPubMedGoogle Scholar
  30. 34.
    Terasawa T, Blackmore CC, Bent S, Kohlwes RJ. Systematic review: computed tomography and ultrasonography to detect acute appenditicitis in adults and adolescents. Ann Intern Med. 2004;141:537–46.CrossRefPubMedGoogle Scholar
  31. 35.
    Moteki T, Horikoshi H. New CT criterion for acute appendicitis: maximum depth of intraluminal appendiceal fluid. Am J Roentgenol. 2007;188(5):1313–9.CrossRefGoogle Scholar
  32. 36.
    Megibow AJ, et al. Evaluation of bowel distention and bowel wall appearance by using neutral oral contrast agent for multi–detector row CT. Radiology. 2006;238(1):87–95.CrossRefPubMedGoogle Scholar
  33. 37.
    Morrow SE, Newman KD. Current management of appendicitis. Semin Pediatr Surg. 2007;16:34–40.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • F. Monetti
    • 1
  • A. Bhangu
    • 2
  • S. Di Saverio
    • 3
  • M. Stellino
    • 4
  • P. E. Orlandi
    • 1
  • M. Imbriani
    • 1
  1. 1.Department of RadiologyMaggiore HospitalBolognaItaly
  2. 2.Academic Department of SurgeryUniversity of BirminghamBirminghamUK
  3. 3.Cambridge Colorectal UnitCambridge University Hospitals NHS Foundation Trust, Addenbrooke’s HospitalCambridgeUK
  4. 4.Department of NeuroradiologyBellaria HospitalBolognaItaly

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