Study on 35 patients with ages of 10 suspected with the appendicitis diagnosed by ultrasound. The results have shown that the appendicitis most frequently occurred in persons with ages of 21-60. The diameter of appendicitis was about 8-10 mm by ultrasound. There was no suitability between ultrasound and operation for symptoms of fluid in the terminal bag of Douglas and pelvic cavity.
Appendicitis ; ultrasonography ; diagnosis

Although the ultrasonography has been regarded as a important procedure in the diagnosis of intraabdominalabscess, there were relatively few papers concerning the ultrasonographic findings of periappendiceal abscess.Nineteen cases of surgically proven periappendiceal abscess caused by perforated appendicitis were studied byultrasonography at the Kyung Hee University Hospital during last 34 months. The results were as follows; 1.Diagnostic accuracy of the real-time ultrasonography was 94.7%(18/19). There were only one false positive and onefalse negative. 2. The location of abscesses were ; periappendiceal 68.4%(13/19), pelvic 21.0%(4/19), subhepatic5.3%(1/19) and subphrenic 5.3%(1/19) in order of frequency. 3. Variable echo-patterns of abscesses wereencountered. But irregular, thick walled, posteriorly reinforcing, echo-free or mixed echo-patterns were mostcommon.
Abscess ; Appendicitis ; Diagnosis ; Ultrasonography

The pelvic abscess communicating with the appendix is relatively rare, however, it could be diagnosed preoperatively by various diagnostic modalities such as ultrasonography, computed tomography or laparoscopy. We experienced a case of pelvic abscess presented as a pelvic mass invading vesical wall, and report this unusual presentation with a brief review of literature.
Abscess* ; Appendicitis* ; Appendix ; Laparoscopy ; Ultrasonography

PURPOSE: Ultrasound (US) is one of the most useful modalities to diagnose appendicitis. However, without expert sonographers, the diagnosis of appendicitis via US is limited because it needs much experience to perform properly. Although many emergency physicians (EP) have used US successfully to diagnose appendicitis, there have been few studies comparing the diagnostic accuracy of EP's US with that of experienced radiologists. The purpose of this study is comparing the agreement and the accuracy rate of diagnosis of EP's US with that of experienced radiologists. METHOD: During 2 months, we enrolled 102 patients clinically suspected of having acute appendicitis; then, US was performed by an EP or a radiologist. The US examiner was selected at the time of the patient's arrival. In group I patients US was performed by a senior EP, while in group II patient's, it was performed by a radiologist. If any Group I patients were still in the ED when the radiology department open, US was performed once more by a radiologist. Pathologic reports and final diagnoses were reviewed later. We calculated the sensitivity, the specificity, and the accuracy for each group; then, we compared the accuracies of the two groups and analyzed the agreement of the US diagnoses between the two groups. RESULTS: Of the 102 patients that were enrolled, 62 patients had US performed by an EP, 66 had US performed by a radiologist, and 26 had US performed by both departments' examiners. The accuracies of US in diagnosing acute appendicitis were 93.5% in group I and 90.9% in group II. The agreement of US diagnoses between the two departments' examiners, in the patients had performed US by both departments, results were significantly similar (Kappa=0.708). CONCLUSION: This study suggested that a properly educated EP's sonographic diagnosis of appendicitis has the same diagnostic accuracy as that of a radiologist. Thus for reducing complications of acute appendicitis, it would be valuable for an EP to use US in the diagnostic process.
Appendicitis* ; Diagnosis* ; Emergencies* ; Humans ; Sensitivity and Specificity ; Ultrasonography*

Because primary lymphoma of the appendix is a very rare disorder and commonly presented as acute appendicitis,it is seldom diagnosed by preoperative imaging study. We encountered a patient with pathologically proved primaryappendiceal lymphoma associated with acute and chronic appendicitis. Ultrasonogram revealed a non-compressiblesausage-shaped hypoechoic mass with a linear hyperechoic center caused by mucosa-lumen interface in right lowerquadrant. Post-contrast CT examination showed a markedly enlarged target-like appendix with obliteration of thelumen; the outer layer showed higher attenuation than the central portion. There were also multiple strands in theperiappendiceal fat and thickening of adjacent lateroconal fascia and colonic wall, and this suggested acuteappendicitis associated with appendiceal lymphoma.
Appendicitis* ; Appendix ; Colon ; Fascia ; Humans ; Lymphoma* ; Ultrasonography

PURPOSE: Acute appendicitis is one of the most common surgical diseases and the accuracy of diagnosis has been reported to be between 71% and 85%. In this study we tried to determine whether abdominal sonographic examination is critical to the decision to operate and whether its use is essential before surgery of patients with clinically diagnosed or suspected acute appendicitis. METHODS: A total of 552 patients with clinically diagnosed acute appendicitis from January 2000 to December 2001 were enrolled in this study. All patients underwent an abdominal graded compression sonography performed by a staff radiologist. RESULTS: A total of 535 patients (96.9%) with positive findings of appendicitis proceeded to surgery. 17 patients (3.1%) were found to have other diseases. Of the 535 patients undergoing operation, 531 (99.3%) were proved to have appendicitis by pathologic reports. The 17 patients with negative findings in sonography underwent operation or CT examination; 12 (70.6%) were proved to have appendicitis. Abdominal sonography for detecting acute appendicitis had a sensitivity of 97.8%, a specificity of 55.6%, an accuracy of 97.1%, a positive predictive value of 99.3%, and a negative predictive value of 29.4%. CONCLUSION: Abdominal sonography is therefore one of the most useful examinations in diagnosing acute appendicitis before surgery and our experience suggests that patients with clinically suspected acute appendicitis should routinely undergo abdominal sonographic examination.
Appendicitis* ; Diagnosis ; Humans ; Sensitivity and Specificity ; Ultrasonography

PURPOSE: To analyze surgical specimens from patients with acute non-perforated and perforated appendicitis using high-resolution ultrasonography (US), and to correlate the US features with the pathologic findings. MATERIALS and METHODS: One hundred and six surgical appendix specimens obtained from patients with suspected acute appendicitis were evaluated. The following US features were evaluated for differentiating acute non-perforated appendicitis from perforated appendicitis: circumferential loss of the echogenic submucosal layer, disruption of the serosal layer, asymmetrical wall thickening, the sum of opposing walls > or = 9 mm and the presence of appendicoliths. The sensitivity and specificity of the US findings for diagnosing perforated appendicitis were determined. RESULTS: All US features were detected significantly more often in the perforated appendicitis group of specimens. The disruption of the serosal layer was the most significant independent predictor of perforation (p < .001). The sensitivity for circumferential loss of the echogenic submucosal layer, disruption of the serosal layer, asymmetrical wall thickening, wall thickness > or = 9 mm, and the presence of appendicoliths individually was 84.6%, 69.2%, 61.5%, 73.1% and 46.2%, respectively. The specificity for all of these findings was 86.3%, 98.7%, 95.0%, 85.0% and 85.0%, respectively. CONCLUSION: High-resolution US of appendiceal specimens was very useful for differentiating acute non-perforated from perforated appendicitis.
Appendicitis* ; Appendix ; Humans ; Sensitivity and Specificity ; Ultrasonography*

PURPOSE: To decrease the high negative appendectomy rate, in addition to the traditional history-taking, physical examination, and laboratory findings, additional sensitive and specific examinations are necessary. The authors conducted a study to evaluate the value of ultrasonographic examination in the diagnosis of acute appendicitis in patients with clinically suspected appendicitis. METHODS: During 18 months from July 1, 1998 through December 31, 1999, a total of 290 patients were enrolled into the study. Altogether 110 abdominal sonographic examinations were performed by the staff radiologist, in all cases of clinically suspected appendicitis. The improvement of diagnostic accuracy was compared with the historical control group of 240 patients during the period of 18 months from January 1, 1997 through June 30, 1998. RESULTS: Clinical diagnosis (without sonographic examination) was made in 180 patients (157 appendicitis, and 23 non-appendicitis). Negative appendectomy was performed in 24 patients. Sonographic diagnosis was made in 110 patients with clinically suspected appendicitis (91 appendicitis, and 19 non-appendicitis). Negative appendectomy was done in 9 patients. Nineteen patients without positive sonographic findings of appendicitis could be spared the negative appendectomy. Abdominal sonography for detecting acute appendicitis had a sensitivity of 100.0%, a specificity of 67.9%, an accuracy of 91.0%, a positive predictive value of 90.1%, and a negative predictive value of 100.0%. By adding ultrasonographic examinations in all cases of clinically suspected appendicitis, diagnostic specificity was increased significantly over the historical control group (P<0.01). CONCLUSIONS: Although the value of meticulous history- taking, physical examination, and laboratory tests cannot be overemphasized, our experience suggests that patients with clinically suspected appendicitis should routinely undergo abdominal sonographic examinations, performed by experienced radiologists and surgeons, to further decrease the negative appendectomy rates.
Appendectomy ; Appendicitis* ; Diagnosis ; Humans ; Physical Examination ; Sensitivity and Specificity ; Ultrasonography

PURPOSE: To compare the accuracy of initial clinical diagnosis with that of ultrasonography(US) in diagnosingappendicitis and to determine its effect on the care of patients in a community hospital. MATERIALS AND METHODS: One hundred and fifty patients with suspected appendicitis were prospectively examined with US. Prior to this,they had been divided into three groups on the basis of clinical judgement regarding diagnosis and their treatmentplan: Group I : high suspicion (probability > 75%) - urgent surgery indicated ; Group II : equivocal (probability25 - 75%) - in hospital for observation, Group III : very unlikely (probability < 25%)- discharge without furthertesting. In order to determine the validity of these groupings, we calculated the sensitivity, specificity, andaccuracy of sonographic examination, and the likelihood ratios of initial clinical diagnosis. RESULTS: USrevealed a sensitivity of 92%, specificity of 90%, positive predictive value of 95%, negative predictive value of85% and overall accuracy of 91%. The initial clinical impression showed a sensitivity of 70%, specificity of 82%,positive predictive value of 89%, negative predictive value of 58%, and overall accuracy of 74%. Among 79 patientsin the high clinical risk category (Group I), the sensitivity, specificity and accuracy of US were 96%, 89%, and95%, respectively. Among 71 patients in the low- and intermediate- clinical categories (Groups II and III), thesensitivity, specificity, and accuracy of US were 83%, 90%, and 87%. The likelihood ratios were 3.9 in Group I,0.52 in Group II, and 0.15 in Group III. In 32 of 150 patients (21%), the findings of US led to changes in theproposed management plan. CONCLUSION: The overall accuracy of US in the diagnosis of appendicitis wasstatistically superior to that of the clinician's initial impression (p<0.05). In addition, US played an importantrole in making decisions regarding the treatment plan.
Appendicitis* ; Diagnosis* ; Hospitals, Community* ; Humans ; Prospective Studies ; Sensitivity and Specificity ; Ultrasonography

PURPOSE: Studies on the relationship between appendiceal inflammation and bedside ultrasonographic findings are lacking. The purpose of this study was to determine statistically significant parameters to diagnose appendicitis earlier by comparing ultrasonographic findings and clinical features between early and late appendicitis. METHODS: A registry of right lower quadrant (RLQ) pain ultrasound from December 2011 to December 2012 was reviewed. Among these cohorts, patients pathologically proven to have appendicitis were selected and divided into two groups: an early appendicitis group, patients who complained of a diffuse abdominal pain, and a late appendicitis group, patients who complained of a localized right lower quadrant pain. The two groups were compared according to gender, age, bedside ultrasonographic findings, inflammatory markers, clinical features, and postoperative pathological findings. RESULTS: A total of 102 patients were enrolled in this study. Among them, 42 patients (41.2%) were in the early appendicitis group and 60(58.8%) were in the late appendicitis group. Appendiceal diameter and noncompressibility did not differ between the groups. However, periappendiceal fat infiltration and fluid were less prevalent in the early group (p=0.031 vs. p=0.022, respectively). CONCLUSION: Appendiceal diameter and non-compressibility were the only bedside ultrasound findings found in early appendicitis patients. Emergency physicians can detect early appendicitis and prevent complications before the migration of abdominal pain to the RLQ by bedside ultrasonography.
Abdominal Pain ; Appendicitis* ; Biomarkers ; Cohort Studies ; Emergencies ; Humans ; Inflammation ; Ultrasonography*