Mimickers of Acute Appendicitis

Computed Tomography ◽

Emergency Department ◽

Abdominal Pain ◽

Acute Appendicitis ◽

Imaging Modality ◽

Correct Diagnosis ◽

Emergency Setting ◽

Magnetic Resonance Imaging Mri ◽

Clinical Conditions

Acute appendicitis (AA) is a common surgical diagnosis in patients presenting to the Emergency Department with acute abdominal pain. A wide variety of other clinical conditions can present with a very similar presentation to acute appendicitis and therefore it can be occasionally challenging to make the correct diagnosis. In this review paper, the focus is to shed some light on the differential diagnosis of acute appendicitis which includes a variety of gastrointestinal, vascular, urological, and gynaecological conditions. In the emergency setting there are three main imaging modalities to evaluate patients presenting with abdominal pain, this includes computed tomography (CT), ultrasound (US) and magnetic resonance imaging (MRI). The choice of imaging modality for each clinical condition is variable and as such being familiar with those differential diagnoses is vital in deciding what is the best imaging modality for every patient presenting with abdominal pain.

Uterine Lipoleiomyoma: A Report of Two Cases

Journal of Clinical Imaging Science ◽

10.4103/jcis.jcis_13_17 ◽

2017 ◽

Vol 7 ◽

pp. 26 ◽

Cited By ~ 3

Author(s):

Haji Mohammed Nazir ◽

Sankesh Mehta ◽

CR Seena ◽

N Kulasekaran

Keyword(s):

Computed Tomography ◽

Abdominal Pain ◽

Magnetic Resonance ◽

Postmenopausal Women ◽

Crucial Role ◽

Imaging Modality ◽

Lower Abdominal Pain ◽

Resonance Imaging ◽

Pelvic Tumors

We report two cases of uterine lipoleiomyoma in postmenopausal women of ages 52 and 55 years, who presented with complaints of leukorrhea and lower abdominal pain, respectively. Lipoleiomyoma is a rare benign variant of leiomyoma, having an incidence of 0.03%–0.2%. These are benign pelvic tumors which are usually asymptomatic and commonly occur in obese postmenopausal women. However, they can occasionally present with typical leiomyoma symptoms. Imaging plays a crucial role in the diagnosis of benign pelvic tumors. Ultrasonography is the first imaging modality for diagnosis of pelvic tumors in females. Computed tomography and magnetic resonance imaging are specific in demonstrating the uterine origin and fat component.

A Very Rare Complication of Acute Appendicitis: Appendicovesical Fistula

Case Reports in Urology ◽

10.1155/2016/4517029 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3

Author(s):

Deniz Alis ◽

Cesur Samanci ◽

Yesim Namdar ◽

Fethi Emre Ustabasioglu ◽

Elif Yamac ◽

...

Keyword(s):

Computed Tomography ◽

Acute Appendicitis ◽

Imaging Techniques ◽

Rare Complication ◽

Recurrent Abdominal Pain ◽

Definitive Diagnosis ◽

Resonance Imaging ◽

Enterovesical Fistula ◽

Appendicovesical fistula (AVF) is an uncommon type of enterovesical fistula and a very rare complication of acute appendicitis. Herein, we report a case of 39-year-old male patient who presented with persistent urinary tract infection, recurrent abdominal pain, and pneumaturia. Imaging techniques including ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI) were performed to identify the abnormality. However, definitive diagnosis of AVF was made by cystoscopy.

Evaluation of Cartilage in the Wrist using Magnetic Resonance Imaging

Current Rheumatology Reviews ◽

10.2174/1573397115666190819153912 ◽

2020 ◽

Vol 16 (3) ◽

pp. 170-177

Author(s):

Wesley N. Sivak ◽

Joseph E. Imbriglia

Keyword(s):

Magnetic Resonance ◽

Wrist Arthroscopy ◽

Resonance Imaging ◽

Joint Surfaces ◽

Articular Cartilage Surface ◽

Small Joint ◽

Magnetic Resonance Imaging Mri ◽

Clinical Conditions ◽

Accurate Imaging

Wrist pain is a common patient complaint with a myriad of clinical conditions that can explain the underlying cause. Short of wrist arthroscopy, no technique other than formal wrist arthrotomy exists for direct examination of the hyaline cartilage coating the articular surfaces of the carpal bones. Magnetic resonance imaging (MRI) has been proven accurate in evaluating joint surfaces of large joints such as the shoulder, hip, and knee with articular cartilage surface thickness is in excess of 1 mm. However, in the carpus the thickness of the cartilage and the contours present have precluded accurate imaging. Advances in MRI technology over the last several decades are now making imaging of small joint surfaces, such as the carpus, an area worth revisiting. Herein we provide a review of these efforts with a specific focus on the evaluation of the wrist.

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

Journal of Clinical Medicine ◽

10.3390/jcm10112456 ◽

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.

A243 A RETROSPECTIVE REVIEW OF THE RADIOGRAPHIC DIAGNOSIS AND SURGICAL RESECTION RATES OF PANCREATIC SEROUS CYSTS

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.241 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 300-301

Author(s):

M Monachese ◽

S Li ◽

M Salim ◽

L Guimaraes ◽

P D James

Keyword(s):

Computed Tomography ◽

Magnetic Resonance ◽

Surgical Resection ◽

Predictive Value ◽

Resected Specimen ◽

Cystic Lesions ◽

Resonance Imaging ◽

Guided Biopsy ◽

Abstract Background Pancreatic cystic lesions are increasingly identified in persons undergoing abdominal imaging. Serous cystic neoplasms (SCNs) have a very low risk of malignant transformation. Resection of SCNs is not recommended in the absence of related symptoms. The accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) to identify SCNs is not known and may impact clinical care. Aims To evaluate the accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) for the diagnosis of SCN. To see how this can impact the decision to resect suspected SCNs. Methods Retrospective cohort study of patients from the University Health Network with suspected SCNs from 2017–2020 who underwent either a CT or MRI of the abdomen. Reports noting pancreatic cystic lesions were identified and reviewed. Only cases with suspected SCNs were included. Clinical (age, sex, symptoms, treatment) and radiographic (type of imaging, reported cyst characteristics) data was collected. Pathology was reviewed for all cases where the cysts was biopsied or resected during follow-up. The gold standard for the diagnosis for SCN was pathology of resected specimen or EUS-guided biopsy cytopathology showing no evidence of a mucinous lesion, CEA level below 10ug per L and amylase level below 50 U/L. Results 163 patients were included in the study. 99 (61%) were female and 98 (60%) underwent CT scan. EUS-guided biopsy was performed in 24 (15%) of patients and 8 (5%) had surgical resection. Multidisciplinary review was performed in 6 of the 8 cases that went to surgery. Of the resected specimens, 5 (63%) were SCN, 1 was a mucinous cystic lesion, 1 was a neuroendocrine tumor and 1 was a carcinoma. Two patients underwent EUS evaluation prior to surgical resection. In one case SCN was resected when EUS reported an undetermined cyst type. Reasons for surgical resection were: the diagnosis of serous cyst was not definitive (n=5), symptoms (n=2), and high-risk mucinous cystic neoplasm identified on EUS (n=1). Of 30 patients with pathology available, 15 (50%) were confirmed to have a SCN. CT and MRI had a sensitivity, specificity, positive predictive value and negative predictive value of 93%, 25%, 52% and 80%, respectively. Conclusions Surgical resection for SCN lesions is driven by diagnostic uncertainty after cross-sectional imaging. Multidisciplinary review and EUS evaluation may improve diagnostic accuracy and should be considered prior to surgical resection of possible SCN lesions. Funding Agencies None

Magnetic Resonance Imaging of Spinal Cord Disease of Childhood

PEDIATRICS ◽

10.1542/peds.78.2.251 ◽

1986 ◽

Vol 78 (2) ◽

pp. 251-256

Author(s):

Roger J. Packer ◽

Robert A. Zimmerman ◽

Leslie N. Sutton ◽

Larissa T. Bilaniuk ◽

Derek A. Bruce ◽

...

Keyword(s):

Spinal Cord ◽

Magnetic Resonance ◽

Vertebral Body ◽

Congenital Anomalies ◽

Correct Diagnosis ◽

Surface Coil ◽

Resonance Imaging ◽

Spinal Cord Disease ◽

Correct diagnosis of spinal cord disease in childhood is often delayed, resulting in irreversible neurologic deficits. A major reason for this delay is the lack of a reliable means to noninvasively visualize the spinal cord. Magnetic resonance imaging (MRI) should be useful in the evaluation of diseases of the spinal cord. A 1.5 Tesla MRI unit with a surface coil was used to study 41 children, including eight patients with intrinsic spinal cord lesions, eight patients with masses compressing the cord, 12 patients with congenital anomalies of the cord or surrounding bony structures, three patients with syrinxes, and three patients with vertebral body abnormalities. Intrinsic lesions of the cord were well seen in all cases as intrinsic irregularly widened, abnormally intense cord regions. MRI was helpful in following the course of disease in patients with primary spinal cord tumors. Areas of tumor were separable from syrinx cavities. Extrinsic lesions compressing the cord and vertebral body disease were also well visualized. Congenital anomalies of the spinal cord, including tethering and lipomatous tissue, were better seen on MRI than by any other radiographic technique. MRI is an excellent noninvasive "screening" technique for children with suspected spinal cord disease and may be the only study needed in many patients with congenital spinal cord anomalies. It is also an excellent means to diagnose and follow patients with other forms of intra- and extraspinal pathology.

Appendicitis: a rare adverse event in colonoscopy

BMJ Case Reports ◽

10.1136/bcr-2021-242523 ◽

2021 ◽

Vol 14 (7) ◽

pp. e242523

Author(s):

Samer Al-Dury ◽

Mohammad Khalil ◽

Riadh Sadik ◽

Per Hedenström

Keyword(s):

Emergency Department ◽

Adverse Event ◽

Abdominal Pain ◽

Acute Appendicitis ◽

Physical Examination ◽

De Novo ◽

Perforated Appendicitis ◽

Lower Quadrant ◽

The Right ◽

Right Lower Quadrant

We present a case of a 41-year-old woman who visited the emergency department (ED) with acute abdomen. She was diagnosed with perforated appendicitis and abscess formation on CT. She was treated conservatively with antibiotics and discharged. On control CT 3 months later, the appendix had healed, but signs of thickening of the terminal ileum were noticed and colonoscopy was performed, which was uneventful and showed no signs of inflammation. Twelve hours later, she developed pain in the right lower quadrant, followed by fever, and visited the ED. Physical examination and blood work showed signs consistent with acute appendicitis, and appendectomy was performed laparoscopically 6 hours later. The patient recovered remarkably shortly afterwards. Whether colonoscopy resulted in de novo appendicitis or exacerbated an already existing inflammation remains unknown. However, endoscopists should be aware of this rare, yet serious complication and consider it in the workup of post-colonoscopy abdominal pain.

Occlusal stabilization appliance: evaluation of its efficacy in the treatment of temporomandibular disorders

Journal of Applied Oral Science ◽

10.1590/s1678-77572004000300015 ◽

2004 ◽

Vol 12 (3) ◽

pp. 238-243 ◽

Cited By ~ 9

Author(s):

Elisa Emi Tanaka ◽

Emiko Saito Arita ◽

Bunji Shibayama

Keyword(s):

Magnetic Resonance ◽

Temporomandibular Joint ◽

Temporomandibular Disorders ◽

Imaging Modality ◽

Clinical Status ◽

Signs And Symptoms ◽

Resonance Imaging ◽

Magnetic Resonance Imaging Mri ◽

Mri Evaluation

Occlusal stabilization appliances or splints are the most widely employed method for treatment of temporomandibular disorders (TMD). Magnetic Resonance Imaging (MRI) is the most indicated imaging modality to evaluate the components of the temporomandibular joint (TMJ). Forty patients with signs and symptoms of temporomandibular disorders were treated with splints for a mean period of 12 months, comprising regular semimonthly follow-ups. After stabilization of the clinical status, occlusal adjustments and MRI evaluation were performed. It was concluded that the success of this kind of treatment are related to the total (70%) or partial improvement (22.5%) of painful symptomatology and to the functional reestablishment of the craniomandibular complex. The MRI allowed evaluation and also the conclusion that the splints provide conditions for the organism to develop means to resist to the temporomandibular disorders by means of elimination of several etiologic factors. Moreover, after treatment the patients are able to cope with disc displacements with larger or smaller tolerance.

Imaging of larynx: Diagnostic value of computed tomography and magnetic resonance imaging

Acta chirurgica iugoslavica ◽

10.2298/aci0903039m ◽

2009 ◽

Vol 56 (3) ◽

pp. 39-44

Author(s):

R.M. Maksimovic ◽

B.A. Banko ◽

J.P. Milovanovic

Keyword(s):

Computed Tomography ◽

Magnetic Resonance ◽

Regional Lymph Node ◽

Diagnostic Value ◽

Resonance Imaging ◽

Precise Diagnosis ◽

Node Metastases ◽

Computed tomography (CT) and magnetic resonance imaging (MRI) are enabling more precise diagnosis and treatment planning in patients with diseases of the larynx. The aim of this article is to describe the role of these methods in assessment of the laringeal diseases and key local anatomic characteristics important for spread of the disease. CT and MRI have a valuable contribution to the staging of the tumors due to the possibility to show the relationship to the ventricular complex, involvement of the subumucosal spaces, defining craniocaudal and anterposterior extension, laringeal cartilage invasion, as well as regional lymph node metastases.

Computed Tomography Imaging in Lemmel Syndrome: A Report of Two Cases

Journal of Clinical Imaging Science ◽

10.25259/jcis-17-2019 ◽

2019 ◽

Vol 9 ◽

pp. 23

Author(s):

Giulia Frauenfelder ◽

Annamaria Maraziti ◽

Vincenzo Ciccone ◽

Giuliano Maraziti ◽

Oliviero Caleo ◽

...

Keyword(s):

Computed Tomography ◽

Abdominal Pain ◽

Bile Duct ◽

Common Bile Duct ◽

Acute Abdominal Pain ◽

Imaging Modality ◽

Biliary Duct ◽

History Of ◽

The Common ◽

Solid Lesions

Lemmel syndrome is a rare and misdiagnosed cause of acute abdominal pain due to a juxtapapillary duodenal diverticulum causing mechanical obstruction of the common bile duct. Frequently, patients suffering from Lemmel syndrome have a history of recurrent access to the emergency room for acute abdominal pain referable to a biliopancreatic obstruction, in the absence of lithiasis nuclei or solid lesions at radiological examinations. Ultrasonography (US) may be helpful in evaluation of upstream dilatation of extra-/intra-hepatic biliary duct, but computed tomography (CT) is the reference imaging modality for the diagnosis of periampullary duodenal diverticula compressing the intrapancreatic portion of the common bile duct. Recognition of this entity is crucial for targeted, timely therapy avoiding mismanagement and therapeutic delay. The aim of this paper is to report CT imaging findings and our experience in two patients affected by Lemmel syndrome.