Diagnosing Appendicitis

US is the screening modality of choice in the child suspected of appendicitis, pyloric stenosis and intussusception, and has already proven its utility in diagnosing other diseases both as a screening and as a follow-up modality. Other indications will be discussed in the appropriate sections. 

Graded Compression Sonography for Appendicitis 194 Diagnostic Criteria 195 The Use of CT in Diagnosing Acute Appendicitis 196... 

The main goal of imaging methods is to diagnose appendicitis quickly with high accuracy, non-invas-ive, cost-effective methods and to provide differential diagnosis without laparotomy (Puylaert 1986a). 

Sonography is usedmainly on account ofwidespread availability and the fart that no radiation is used. First of all, diagnosing appendicitis needs sufficient skill and expertise in the performance of gastrointestinal ultrasound. Various compression techniques are used to visualize the appendix (Lee et al. 2005). 

Transvaginal sonography is used maiifly to diagnose gynaecological pathologies. When the appendix is deeply situated in the small pelvis, transvaginal sonographymay also reveal appendicitis (Molander et al. 2002). 

Inflammation of the urinary tract may nuniic appendicitis. A stone in the right ureter may be a cause of right lower abdominal pain. In acute renal colic, the collecting system may not be dilated. Doppler sonography can be used to diagnose the acute obstruction. Furthermore, a carefid search for perirenal fluid at the poles of the kidney should be performed. 

Sonography is the first-hne imaging method for diagnosing acute appendicitis. Experienced investigators have an accuracy of more than 90%. 

Lee JH, Jeong YK, Park KB et al. (2005) Operator-dependent techniques for graded compression sonography to detect the appendix and diagnose acute appendicitis. Am J Roentgenol 184 91-97... 

Fig. 17.15a,b. Right-sided diverticulitis. Trans-axial CT scans at the level of the pelvic crest at the initial presentation (a) and after 3 weeks (b). In a 33-year-old woman who presented with acute right quadrant pain and laboratory signs of inflammation, a diffuse inflammatory process (arrow) in the pericecal region is demonstrated. It was diagnosed as acute retrocecal appendicitis (a). At surgery, there was no evidence of inflammatory changes of the appendix. The follow-up 3 weeks later demonstrated complete resolution of the inflammatory reaction and revealed several diverticula (arrow) of the cecum (b)... 

Diagnosing Appendicitis 613 17.5 Natural Radioactivity and 17.8 Nuclear Power Using Fission to... 

Eor example, appendicitis, the infection and inflammation of the appendix, is difficult to diagnose with certainty. Doctors can use radioactivity to determine if an appendix is indeed infected. Technetium-99m is incorporated into antibodies and administered to the patient. If the appendix is infected, the antibodies, and therefore the technetium-99m, concentrate there. A bright exposure on the developed film in the area of the appendix constitutes a positive test, allowing the surgeon to operate with confidence that he or she is removing an infected appendix. 

Although my symptoms were consistent with appendicitis, the negative blood test clouded the diagnosis. The doctor said that I could elect to have my appendix ranoved anyway (even though it might be healthy) or I could submit to another test that might confirm the appendicitis. I chose the additional test, which involved nuclear medicine, an area of medical practice that employs radioactivity to diagnose and treat disease. Radioactivity is... 

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