scholarly journals Combination of Alvarado score and ultrasound findings in diagnosis of acute appendicitis in children

2017 ◽  
Vol 1 ◽  
pp. 1
Author(s):  
Tamer Fakhry ◽  
Mohamed Shawky
Keyword(s):  
Acute Appendicitis ◽  
Imaging Modality ◽  
Radiology Department ◽  
University Hospitals ◽  
Normal Appendix ◽  
Differential Leukocyte Count ◽  
Alvarado Score ◽  
Ultrasound Findings ◽  
Clinical Scoring ◽  
Us Findings

Appendicitis is the most common cause of emergency abdominal surgeries in children. Ultrasound (US) has been proven to be a helpful imaging modality in patient evaluation, especially in children suspected of appendicitis. The Alvarado score is a 10-point scoring system for the diagnosis of appendicitis based on clinical data and differential leukocyte count. The aim of the present study was to evaluate a combination of clinical scoring (Alvarado score) and US findings for accurate diagnosis of appendicitis in children. The study was done in Menoufia University Hospitals from March 2011 to January 2013. 322 children with abdominal pain clinically suspected of having appendicitis were included in the study and clinically assessed to calculate the Alvarado score. Patients were referred to the radiology department for abdominal US. Among the 153 of the 322 patients who were operated on, 149 patients were diagnosed pre-operatively with acute appendicitis and 4 girls were diagnosed with complex ovarian cysts. Of the 149 patients diagnosed with appendicitis, the percentage of appendicitis was 93% (139/149) and 10 (7%) patients had normal appendix. The prevalence of appendicitis among the patients of the study was 43% (139/322). In conclusion, a combination of Alvarado scores and abdominal US is a good approach for the diagnosis of appendicitis in children to reduce the number of laparotomies for normal appendix. In the case of normal appendix or nonvisualization of the appendix via abdominal US without a high Alvarado score, appendicitis can be safely ruled out. If it is proven as an inflamed appendix on US or a high Alvarado score, patient should be subjected for appendectomy without delay.

scholarly journals Clinical and histopathological analysis of the patients undergoing appendectomy

2018 ◽  
Vol 8 (2) ◽  
pp. 1337-1340
Author(s):  
Kamal Koirala ◽  
Shiva Raj KC ◽  
Ganesh Simkhada ◽  
Rupesh Mukhiya ◽  
Nisheem Pokharel ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Histopathological Examination ◽  
Diagnostic Tools ◽  
Histopathological Analysis ◽  
Negative Appendectomy ◽  
Alvarado Score ◽  
Female Ratio ◽  
Medical College ◽  
Clinical Scoring ◽  
Modified Alvarado Score

Background: Acute appendicitis is one of the most common surgical emergencies, but the diagnosis is difficult even with the sophisticated diagnostic tools. The aim of this study is to analyze the clinical and histopathological features of acute appendicitis and to see how reliable the clinical scoring system modified Alvarado score in our setup.Materials and Methods: This was a retrospective observational study of patients who underwent appendectomy at KIST Medical College and Teaching Hospital during two years. The clinical characteristics of the patients in terms of modified Alvarado scoring were outlined. The diagnosis of acute appendicitis was confirmed by histopathological examination. The data were tabulated in MS-Excel and statistically analyzed using SPSS statistics software, version 21.Results: Among 118 patients, who underwent appendectomy, 69 were male and 49 were female with male to female ratio of 1.41:1 and mean age of 27.46±12.724 years.The clinical diagnosis of acute appendicitis was more likely (MAS 7-9) in 56 patients, less likely (4–6) in 44 patients and unlikely (MAS 1-3) in 18 patients. The highest incidence of acute appendicitis was observed in 19-40 years and the lowest incidence in 61 years or above. After histopathological examination, 52 patients out of 56 in the more likely group had acute appendicitis and 4 patients had non-inflamed appendices. 7 patients out of 62 in the less likely and unlikely groups had acute appendicitis and 55 patients had non-inflamed appendices. The overall negative appendectomy rate was 9.32 percent.Conclusion: Our clinical practice of using modified Alvarado score in the diagnosis of acute appendicitis is effective, easy and non-invasive.

scholarly journals Appendicular Lymphoid Hyperplasia in the Differential Diagnosis of Acute Appendicitis: Sonographic Findings

2019 ◽  
Vol 36 (1) ◽  
pp. 19-23
Author(s):  
Carolina Whittle ◽  
Lizbet Pérez ◽  
Marcela Cortes ◽  
Margarita Switt ◽  
Javiera Aguirre ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Retrospective Study ◽  
Acute Appendicitis ◽  
Demographic Data ◽  
Lymphoid Hyperplasia ◽  
Normal Appendix ◽  
The Mean ◽  
Us Findings ◽  
Inflammatory Changes ◽  
Mucosal Thickening

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.

scholarly journals Accuracy of Ultrasound in the Diagnosis of Acute Appendicitis and Correlation with Histopathology

2018 ◽  
Vol 8 (2) ◽  
pp. 13-19
Author(s):  
Aimandu Shrestha ◽  
Hensan Khadka ◽  
Baburam Poudel ◽  
Ranga Bahadur Basnet ◽  
Siv Bahadur Basnet
Keyword(s):  
Acute Appendicitis ◽  
Leukocyte Count ◽  
Total Leukocyte Count ◽  
Radiology Department ◽  
Clinical Impression ◽  
Negative Appendectomy ◽  
Differential Leukocyte Count ◽  
Diagnostic Modality ◽  
Predictive Values ◽  
Negative Appendectomy Rate

Introduction: Acute appendicitis is a common surgical condition; yet its diagnosis can be elusive at times and missed diagnosis can lead to attendant complications of perforation and its sequelae. On the contrary, negative appendectomy subjects one to unnecessary surgery and its physiological and psychological consequences. Among the various available modalities of diagnosis of appendicitis, Ultrasonography(USG) is easily accessible, non invasive, less time consuming, low cost investigation no radiation hazards. So, USG is appropriate diagnostic modality in our country.Methods: This prospective observational study was carried out from January 2011 to June 2011, in the radiology department of Bir hospital. Total of 80 cases with clinical impression of acute appendicitis were enrolled. These patients underwent surgery for suspected acute appendicitis. Details of signs and symptoms, lab findings including Total Leukocyte count (TLC), Differential Leukocyte Count (DLC) and USG findings were recorded. Intra-operative and histopathology findings were also recorded. The findings were analyzed to assess accuracy of ultrasonography in acute appendicitis. Histopathological report was considered the goal standard.Results: A total of 93 cases clinically diagnosed as acute appendicitis were subjected for USG. Out of 93 cases, 80 cases underwent surgery. Among 80 cases, sonography showed acute appendicitis in 56 cases out of which 54 was proved by histopathology as well. However, ultrasonography was not able to detect appendicitis in 9 cases. The sensitivity and specificity of USG for acute appendicitis were 87.7% and 88.2% respectively. The positive and negative predictive values were 96.4% and 62.5% respectively. Overall negative appendectomy rate of 21.2% had been used a basis for decision making, the rate of error being 13.7%.Conclusion: Ultrasonography is a fairly accurate and safe modality in acute appendicitis. It can be useful in reducing negative appendectomy rate.

scholarly journals Evaluation of Clinical Alvarado Scoring System and CT Criteria in the Diagnosis of Acute Appendicitis

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Idil Gunes Tatar ◽  
Kerim Bora Yilmaz ◽  
Alpaslan Sahin ◽  
Hasan Aydin ◽  
Melih Akinci ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Scoring System ◽  
Acute Abdominal Pain ◽  
Imaging Modality ◽  
Signs And Symptoms ◽  
Study Patient ◽  
Abdominal Ct ◽  
Alvarado Score ◽  
Patient Demographics ◽  
Wbc Count

Aim. The aim was to evaluate the clinical Alvarado scoring system and computed tomography (CT) criteria for the diagnosis of acute appendicitis.Material and Methods. 117 patients with acute abdominal pain who underwent abdominal CT were enrolled in this retrospective study. Patient demographics, clinical Alvarado scoring, CT images, and pathologic results of the patients were evaluated.Results. 39 of the 53 patients who were operated on had pathologically proven acute appendicitis. CT criteria of appendiceal diameter, presence of periappendiceal inflammation, fluid, appendicolith, and white blood cell (WBC) count were significantly correlated with the inflammation of the appendix. The best cut-off value for appendiceal diameter was 6.5 mm. The correlation between appendiceal diameter and WBC count was 80% (P=0.01<0.05). The correlation between appendiceal diameter and Alvarado score was 78.7% (P=0.01<0.05).Conclusion. Presence of CT criteria of appendiceal diameter above 6.5 mm, periappendiceal inflammation, fluid, and appendicolith should prompt the diagnosis of acute appendicitis. Since patients with acute appendicitis may not always show the typical signs and symptoms, CT is a helpful imaging modality for patients with relatively low Alvarado score and leukocytosis and when physical examination is confusing.

scholarly journals Comparison of Alvarado Score and Paediatric Appendicitis Score for Diagnosing Appendicitis in Children

Esculapio ◽  
2021 ◽  
Vol 17 (2) ◽  
pp. 175-178
Author(s):  
Naeem Liaqat ◽  
Asif Iqbal ◽  
Wajeeh Ur Reham ◽  
Zulfiqar Ahmed ◽  
Fozia Bashir ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Clinical Judgment ◽  
P Value ◽  
Normal Appendix ◽  
Alvarado Score ◽  
Biopsy Report ◽  
The Mean ◽  
The Difference ◽  
Appendicitis Score

Objective: To compare diagnostic accuracy of Alvarado score (AS) and Paediatric Appendicitis Score (PAS) for diagnosis of acute appendicitis in children. Methods: This study was conducted at the department of Pediatric Surgery Children Hospital Lahore, over a period of 1 year. All the patients undergoing appendicectomy were included. Alvarado score and Pediatric Appendicitis score (PAS) was evaluated, compared and appendix specimen sent for histopa-thology. All findings were recorded in proforma. The collected data was analyzed by SPSS version 24. The mean Alvarado score and PAS was calculated, and stratified according to the histopathology reports. The sensitivity and specificity of both Alvarado score and PAS for three strata including score 3-5, 5-7 and 8-10 were also calculated. Results: A total of 177 patients were included in the study. The mean age of the patients was 9.16 ± 2.386 years. Among these 118 patients (67%) were male. The mean duration of pain was 21.42 ± 19.05 hours. Biopsy report showed that 18 patients (10.1%) had normal appendix with no signs of inflammations while 159 patients (89.9%) had inflammation on histopathology. We stratified the histopathology reports according to Alvarado score ≤7 and >7 and P-value was found significant. Similarly PAS ≤7 and >7 was stratified and P-value was not significant. The difference in mean Alvarado score between having acute appendicitis and those with normal histopathology was significant (P= 0.000) while this difference in mean PAS was not found significant (P= 0.325). Conclusions: None of the scoring system has adequate diagnostic accuracy and clinical judgment is preferred. Key Words: Alvarado Score; PAS; Appendicitis; Children How to cite: Liaqat N., Iqbal A., Rehman ur W., Ahmed Z., Bashir F., Dar H.S. Comparison of Alvarado score and Paediatric Appendicitis Score for diagnosing appendicitis in children” Esculapio 2021;17(02):175-178.

Knee pain: Ultrasound and MRI correlation

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mahmoud Mustafa Mohamed Kamal Eldin ◽  
Hana HamdyNasef ◽  
Mennatallah Hatem Shalaby
Keyword(s):  
Soft Tissue ◽  
Knee Pain ◽  
Tissue Injury ◽  
Imaging Modality ◽  
Soft Tissue Injury ◽  
Lateral Collateral Ligament ◽  
Radiology Department ◽  
University Hospitals ◽  
Collateral Ligament ◽  
Ligament Sprain

Abstract Background Knee pain incidence is increasing among the community which has different multiple pathologies. Magnetic Resonance Imaging (MRI) is considered the gold standard imaging modality in diagnosing knee soft tissue injury. Ultrasound (US) is another modality which can be used in diagnosing soft tissue injury. Aim of the Work is to detect the reliability of US in diagnosing cases with knee pain as compared to MRI. Patients and Methods A prospective study was conducted on 20 patients with knee pain. They were referred from the Orthopedic and/or Rheumatology Department to Radiology department at Ain Shams University hospitals for MRI and US examination of the knee.The age group were from 19 to 59 years. Results In this study, 20 patients were examined with majority being males (75%). US was tested against MRI for different soft tissue pathologies.including knee effusion, meniscal pathology (tear, degeneration and extrusion), medial collateral ligament sprain, lateral collateral ligament sprain and Baker’s cyst. There was good agreement between US and MRI in most of these pathologies. US showed an overall sensitivity of 61.7% and specificity of 92.7% with accuracy of 86.9%. The overall PPV and NPV were 66.1% and 91.3% respectively. Conclusion Ultrasound can be considered a reliable screening imaging modality in cases of knee pain.

Incidence of Cerebral Hemorrhage in Traumatic Patients using Computed Tomography in Tabuk City, Saudi Arabia

2020 ◽  
Vol 5 (10) ◽  
pp. 460-463
Author(s):  
Amna Mohamed Ahmed ◽  
Towmader Awad ◽  
Hajer Yousif ◽  
Reem Nahari ◽  
Omnia Abdelrhman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Saudi Arabia ◽  
Head Trauma ◽  
Subdural Hematoma ◽  
Cerebral Hemorrhage ◽  
Imaging Modality ◽  
Common Type ◽  
Radiology Department ◽  
Age Group ◽  
Ct Finding

Computed Tomography (CT) is the most commonly used imaging modality in the evaluation of cerebral hemorrhage in the head trauma patients. Objective: To study the incidence of a cerebral hemorrhage in traumatic patients using computed tomography. Method: This retrospective study was conducted at King Khalid hospital in Tabuk city, Saudi Arabia, in the radiology department, in the period from September 2018 to April 2020. The study was done by collecting 471 CT reports of patients all of them were exposed to head trauma with deferent reasons. The data were analyzed by Statistical Package for the Social Sciences (SPSS) program (ver. 20) and presented in tables and graphs according to the checklist which includes: patient age, gender, type of trauma, CT finding, and type of hemorrhage. Results: The most age group suffered from head trauma was less than 20 years percentage (55%), The male patients more exposed to head trauma than female patients with percentage (84.5%), the road traffic accident (RTA) is the most common type of trauma by percentage (63.5%), according to the CT finding; the cerebral hemorrhage represented (15.5%) with the highest percentage in a subdural hematoma (31.2%), the fracture represented (2.8%) while the normal appearance represented (81.7%) as the highest percentage. Conclusion: Most of the traumatic brain injury in patients caused cerebral hemorrhage and the CT scan reports show that: the common type of cerebral hemorrhage is subdural hematoma and it is common in males which exposed to (RTA) in the age group (21 - 40) years old.

scholarly journals Conditional CT Strategy—An Effective Tool to Reduce Negative Appendectomy Rate and the Overuse of the CT

2021 ◽  
Vol 10 (11) ◽  
pp. 2456
Author(s):  
Raminta Luksaite-Lukste ◽  
Ruta Kliokyte ◽  
Arturas Samuilis ◽  
Eugenijus Jasiunas ◽  
Martynas Luksta ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Sensitivity And Specificity ◽  
Surgical Outcomes ◽  
Imaging Modality ◽  
Ct Scans ◽  
Negative Appendectomy ◽  
Transabdominal Ultrasound ◽  
First Choice ◽  
Negative Appendectomy Rate

(1) Background: Diagnosis of acute appendicitis (AA) remains challenging; either computed tomography (CT) is universally used or negative appendectomy rates of up to 30% are reported. Transabdominal ultrasound (TUS) as the first-choice imaging modality might be useful in adult patients to reduce the need for CT scans while maintaining low negative appendectomy (NA) rates. The aim of this study was to report the results of the conditional CT strategy for the diagnosis of acute appendicitis. (2) Methods: All patients suspected of acute appendicitis were prospectively registered from 1 January 2016 to 31 December 2018. Data on their clinical, radiological and surgical outcomes are presented. (3) Results: A total of 1855 patients were enrolled in our study: 1206 (65.0%) were women, 649 (35.0%) were men, and the median age was 34 years (IQR, 24.5–51). TUS was performed in 1851 (99.8%) patients, and CT in 463 (25.0%) patients. Appendices were not visualized on TUS in 1320 patients (71.3%). Furthermore, 172 (37.1%) of 463 CTs were diagnosed with AA, 42 (9.1%) CTs revealed alternative emergency diagnosis and 249 (53.8%) CTs were normal. Overall, 519 (28.0%) patients were diagnosed with AA: 464 appendectomies and 27 diagnostic laparoscopies were performed. The NA rate was 4.2%. The sensitivity and specificity for TUS and CT are as follows: 71.4% and 96.2%; 93.8% and 93.6%. (4) Conclusion: A conditional CT strategy is effective in reducing NA rates and avoids unnecessary CT in a large proportion of patients. Observation and repeated TUS might be useful in unclear cases.

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