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Krisem M, Jenjitranant P, Thampongsa T, Wongwaisayawan S. Appendiceal wall thickness and Alvarado score are predictive of acute appendicitis in the patients with equivocal computed tomography findings. Sci Rep 2023; 13:998. [PMID: 36653425 PMCID: PMC9849407 DOI: 10.1038/s41598-023-27984-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/11/2023] [Indexed: 01/19/2023] Open
Abstract
Around 8-13% of the patients who underwent CT scan for diagnosis of appendicitis had equivocal CT results. About one-third of these patients had acute appendicitis and this caused diagnostic challenge to the clinicians. This study was conducted to identify clinical and imaging features that were predictive of acute appendicitis in patients who had equivocal CT findings. During January 2015 to June 2021, we retrospectively included 103 consecutive CT scans of adult patients (22 men and 81 women; mean age, 39.1 ± 17.5 years) who had equivocal CT findings of acute appendicitis. Two readers, blinded to the clinical data, independently assessed CT images for the relevant CT findings of appendicitis. Any disagreement between the readers was solved by consensus. The clinical parameters and CT findings were analyzed and compared between the patients who had appendicitis and patients who did not have appendicitis. Thirty-one (30.1%) patients had appendicitis, all of which were non-complicated. The appendiceal wall thickness of ≥ 2 mm and the Alvarado score of ≥ 7 were independent predictors of appendicitis with adjusted odds ratios (ORs) of 2.76 (95% CI, 1.09-7.02) and 1.47 (95% CI, 1.12-1.94), respectively. The maximal appendiceal diameter was higher in the appendicitis group (7.2 ± 1.2 mm vs. 6.5 ± 1.0 mm), but not predictive of appendicitis. The rest of the clinical parameters and CT findings, including mucosal hyperenhancement, periappendiceal fat reticulation, thickening of peritoneal reflection, appendicolith, focal cecal thickening, and content in appendiceal lumen showed no significant difference between two groups. The appendiceal wall thickness and the Alvarado score were able to predict appendicitis in patients who had equivocal CT findings.
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Affiliation(s)
- Massupa Krisem
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pinporn Jenjitranant
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tharin Thampongsa
- Trauma, Acute Care Surgery and Surgical Critical Care Unit, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sirote Wongwaisayawan
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Akçiçek M, Ilgar M, Ünlü S. Is acute appendicitis complicated or uncomplicated? Approaching the question via computed tomography. Acta Radiol 2022; 64:1755-1764. [PMID: 36451525 DOI: 10.1177/02841851221141221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background The distinction between complicated and uncomplicated appendicitis is very important for the selection of the treatment method. Purpose To investigate the sensitivity and specificity of computed tomography (CT) in differentiating between complicated and uncomplicated appendicitis to demonstrate that false negativity in differentiating these cases can be reduced when CT findings are incorporated into the clinical evaluation of patients. Material and Methods All patients aged ≥18 years who underwent appendectomy at Malatya Training and Research Hospital in 2020 and 2021 were retrospectively screened. Of them, 283 patients were included in the study who had undergone CT before the operation. Patients with appendicitis were divided into two groups: complicated and uncomplicated, according to the results of their pathology tests. Demographic data, laboratory results, and CT images of the patients were evaluated. Results The patients with complicated appendicitis had a significantly higher mean age ( P<0.001). The most common CT findings in patients with complicated appendicitis were moderate or severe peri-appendiceal fat stranding (PFS) and appendix wall enhancement defect (AWD). The findings with the highest sensitivity were PFS (77.9%) and AWD (69.4%). Although abscess, phlegmon, and peri-appendiceal air had the highest specificity (100%), these findings were the ones with the lowest sensitivity. According to the scoring system was developed for the differential diagnosis, CT had a sensitivity of 83.3% and a specificity of 79.2%. Conclusion Based on the sensitivity and specificity values measured for CT according to the findings of our study, the scoring system may be useful for the differential diagnosis of complicated appendicitis.
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Affiliation(s)
- Mehmet Akçiçek
- Faculty of Medicine, Radiology Department, Malatya Turgut Ozal University, Malatya, Turkey
- Radiology Department, Malatya Training and Research Hospital, Malatya, Turkey
| | - Mehtap Ilgar
- Radiology Department, Malatya Training and Research Hospital, Malatya, Turkey
| | - Serkan Ünlü
- Radiology Department, Malatya Training and Research Hospital, Malatya, Turkey
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CT based Acute Appendicitis Severity Index for acute appendicitis and validate its effectiveness in predicting complicated appendicitis. Emerg Radiol 2021; 28:921-927. [PMID: 34032950 DOI: 10.1007/s10140-021-01950-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
AIM To propose a CT-based scoring system called Acute Appendicitis Severity Index (AASI) for diagnosis of acute appendicitis and validates its effectiveness in predicting complicated appendicitis. SUBJECTS AND METHODS Retrospective analyses of CT images of 120 adult patients with pathologically proven uncomplicated (n = 64) and complicated (n = 56) acute appendicitis were performed. All patients had undergone a CT scan of the abdomen and pelvis using 320 multi-detectors computed tomography with Adaptive Iterative Dose Reduction 3D (AIDR 3D). CT image parameters were identified and used to develop a CT-based scoring system (AASI) to predict the severity of acute appendicitis and its outcome. All image analysis was performed by 2 radiologists and the total score was assigned to each patient based on the proposed CT scoring system. Validation of the effectiveness of the proposed scoring system (AASI) was done using statistical models. RESULTS The mean and standard deviation of AASI was found to be significantly higher (P value = 0.001) in the complicated appendicitis group (observer 1 = 10.2 ± 1.6 and observer 2 = 9.63 ± 2.3) as compared to that in uncomplicated acute appendicitis group (observer 1 = 7.09 ± 2.2 and observer 2 = 6.38 ± 1.9). There was an excellent interobserver agreement of the Acute Appendicitis Severity Index for both the uncomplicated and complicated appendicitis groups (K = 0.89, 95% CI = 0.87-0.92, P = 0.001). The cutoff value for AASI used to predict complicated appendicitis was taken as 9.5 and 8.5. This resulted in an AUC of 0.877 and 0.848, accuracy of 83% and 81%, the sensitivity of 75% and 80%, the specificity of 90% and 81%, the positive predictive value of 87% and 78%, and a negative predictive value of 81% and 83% by both reviewers respectively. CONCLUSION The proposed CT-based AASI is a reliable parameter for the prediction of complicated appendicitis.
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Mahankali SK, Abdel Razek AAK, Ahamed SA. Reliability of standardized reporting system of acute appendicitis in adults at low-dose 320-rows CT. Eur J Radiol Open 2019; 6:330-335. [PMID: 31768408 PMCID: PMC6872863 DOI: 10.1016/j.ejro.2019.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/01/2019] [Accepted: 11/02/2019] [Indexed: 12/26/2022] Open
Abstract
Aim To assess the reliability of a standardized reporting system of acute appendicitis at low-dose 320-rows CT. Subjects and Methods Retrospective analysis CT of 78 patients with pathologically proven acute appendicitis. The study was performed at a low-dose 320-rows CT. The image analysis was performed by 2 radiologists according to a standardized reporting system of acute appendicitis. Results There was an excellent overall of the inter-observer agreement of both observers for the standardized reporting system of acute appendicitis (K = 0.89, 95 % CI = 0.87-0.92, P = 0.001). There was good inter-observer agreement for visualization of the appendix (K = 0.78, P = 0.001), the tip diameter (K = 0.75, P = 0.001), and a single wall thickness of appendix (K = 0.77, P = 0.001). There was excellent inter-observer agreement for outer to outer wall diameter (K = 0.82, P = 0.001), mucosal hyper-enhancement (K = 0.80, P = 0.001), appendicolith (K = 0.86, P = 0.001), gas in the appendix (K = 0.82, P = 0.001), surrounding fat stranding (K = 0.81, P = 0.001), focal cecal thickening (K = 0.85, P = 0.001), peri-appendiceal air (K = 0.87, P = 0.001), peri-appendicular fluid collection, phlegmon, or abscess (K = 0.82, P = 0.001), and right ovary cyst (K = 0.83, P = 0.001). Conclusion we concluded that excellent reliability of a standardized reporting system of acute appendicitis in the adults using low-dose 320-rows CT.
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Park SB, Kim MJ, Ko Y, Sim JY, Kim HJ, Lee KH. Structured Reporting versus Free-Text Reporting for Appendiceal Computed Tomography in Adolescents and Young Adults: Preference Survey of 594 Referring Physicians, Surgeons, and Radiologists from 20 Hospitals. Korean J Radiol 2019; 20:246-255. [PMID: 30672164 PMCID: PMC6342761 DOI: 10.3348/kjr.2018.0109] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 11/15/2018] [Indexed: 12/19/2022] Open
Abstract
Objective To survey care providers' preference between structured reporting (SR) and free-text reporting (FTR) for appendiceal computed tomography (CT) in adolescents and young adults. Materials and Methods An ethical committee approved this prospective study. The requirement for participant consent was waived. We distributed the Likert scale-based SR form delivering the likelihood of appendicitis across 20 hospitals through a large clinical trial. In the final phase of the trial, we invited 706 potential care providers to participate in an online survey. The survey questions included usefulness in patient management, communicating the likelihood of appendicitis, convenience, style and format, and overall preference. Logistic regression analysis was performed for the overall preference. Three months after the completion of the trial, we checked if the use of the SR was sustained. Results Responses were analyzed from 594 participants (175 attendings and 419 trainees; 225 radiologists, 207 emergency physicians, and 162 surgeons). For each question, 47.3–64.8% of the participants preferred SR, 13.1–32.7% preferred FTR, and the remaining had no preference. The overall preference varied considerably across the hospitals, but slightly across the departments or job positions. The overall preference for SR over FTR was significantly associated with attendings, SR experience for appendiceal CT, hospitals with small appendectomy volume, and hospitals enrolling more patients in the trial. Five hospitals continued using the SR in usual care after the trial. Conclusion Overall, the care providers preferred SR to FTR. Further investigation into the sustained use of the SR is needed.
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Affiliation(s)
- Sung Bin Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Min Jeong Kim
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Korea.
| | - Yousun Ko
- Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Ji Ye Sim
- Department of Radiology, Hanil General Hospital, Seoul, Korea
| | - Hyuk Jung Kim
- Department of Radiology, Daejin Medical Center, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Kyoung Ho Lee
- Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea.,Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
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Haijanen J, Sippola S, Grönroos J, Rautio T, Nordström P, Rantanen T, Aarnio M, Ilves I, Hurme S, Marttila H, Virtanen J, Mattila A, Paajanen H, Salminen P. Optimising the antibiotic treatment of uncomplicated acute appendicitis: a protocol for a multicentre randomised clinical trial (APPAC II trial). BMC Surg 2018; 18:117. [PMID: 30558607 PMCID: PMC6296129 DOI: 10.1186/s12893-018-0451-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/28/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Based on epidemiological and clinical data acute appendicitis can present either as uncomplicated (70-80%) or complicated (20-30%) disease. Recent studies have shown that antibiotic therapy is both safe and cost-effective for a CT-scan confirmed uncomplicated acute appendicitis. However, based on the study protocols to ensure patient safety, these randomised studies used mainly broad-spectrum intravenous antibiotics requiring additional hospital resources and prolonged hospital stay. As we now know that antibiotic therapy for uncomplicated acute appendicitis is feasible and safe, further studies evaluating optimisation of the antibiotic treatment regarding both antibiotic spectrum and shorter hospital stay are needed to evaluate antibiotics as the first-line treatment for uncomplicated acute appendicitis. METHODS APPAC II trial is a multicentre, open-label, non-inferiority randomised controlled trial comparing per oral (p.o.) antibiotic monotherapy with intravenous (i.v.) antibiotic therapy followed by p.o. antibiotics in the treatment of CT-scan confirmed uncomplicated acute appendicitis. Adult patients with CT-scan diagnosed uncomplicated acute appendicitis will be enrolled in nine Finnish hospitals. The intended sample size is 552 patients. Primary endpoint is the success of the randomised treatment, defined as resolution of acute appendicitis resulting in discharge from the hospital without the need for surgical intervention and no recurrent appendicitis during one-year follow-up. Secondary endpoints include post-intervention complications, late recurrence of acute appendicitis after one year, duration of hospital stay, pain, quality of life, sick leave and treatment costs. Primary endpoint will be evaluated in two stages: point estimates with 95% confidence interval (CI) will be calculated for both groups and proportion difference between groups with 95% CI will be calculated and evaluated based on 6 percentage point non-inferiority margin. DISCUSSION To our knowledge, APPAC II trial is the first randomised controlled trial comparing per oral antibiotic monotherapy with intravenous antibiotic therapy continued by per oral antibiotics in the treatment of uncomplicated acute appendicitis. The APPAC II trial aims to add clinical evidence on the debated role of antibiotics as the first-line treatment for a CT-confirmed uncomplicated acute appendicitis as well as to optimise the non-operative treatment for uncomplicated acute appendicitis. TRIAL REGISTRATION Clinicaltrials.gov , NCT03236961, retrospectively registered on the 2nd of August 2017.
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Affiliation(s)
- J. Haijanen
- Division of Digestive Surgery and Urology, Turku University Hospital, Kiinanmyllynkatu 4-8, 20520 Turku, Finland
- Department of Surgery, University of Turku, Turku, Finland
- Department of Surgery, Satakunta Central Hospital, Pori, Finland
| | - S. Sippola
- Division of Digestive Surgery and Urology, Turku University Hospital, Kiinanmyllynkatu 4-8, 20520 Turku, Finland
- Department of Surgery, University of Turku, Turku, Finland
| | - J. Grönroos
- Division of Digestive Surgery and Urology, Turku University Hospital, Kiinanmyllynkatu 4-8, 20520 Turku, Finland
- Department of Surgery, University of Turku, Turku, Finland
| | - T. Rautio
- Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - P. Nordström
- Division of Surgery, Gastroenterology and Oncology, Tampere University Hospital, Tampere, Finland
| | - T. Rantanen
- Department of Surgery, Kuopio University Hospital, Kuopio, Finland
- Department of Surgery, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - M. Aarnio
- Department of Surgery, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - I. Ilves
- Department of Surgery, Mikkeli Central Hospital, Mikkeli, Finland
| | - S. Hurme
- Department of Biostatistics, University of Turku, Turku, Finland
| | - H. Marttila
- Department of Hospital Hygiene and Infection Control, Turku University Hospital, Turku, Finland
| | - J. Virtanen
- Department of Radiology, Turku University Hospital, University of Turku, Turku, Finland
| | - A. Mattila
- Department of Surgery, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - H. Paajanen
- Department of Surgery, Mikkeli Central Hospital, Mikkeli, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - P. Salminen
- Division of Digestive Surgery and Urology, Turku University Hospital, Kiinanmyllynkatu 4-8, 20520 Turku, Finland
- Department of Surgery, University of Turku, Turku, Finland
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Sippola S, Grönroos J, Sallinen V, Rautio T, Nordström P, Rantanen T, Hurme S, Leppäniemi A, Meriläinen S, Laukkarinen J, Savolainen H, Virtanen J, Salminen P. A randomised placebo-controlled double-blind multicentre trial comparing antibiotic therapy with placebo in the treatment of uncomplicated acute appendicitis: APPAC III trial study protocol. BMJ Open 2018; 8:e023623. [PMID: 30391919 PMCID: PMC6231590 DOI: 10.1136/bmjopen-2018-023623] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 08/19/2018] [Accepted: 09/04/2018] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Recent studies show that antibiotic therapy is safe and feasible for CT-confirmed uncomplicated acute appendicitis. Spontaneous resolution of acute appendicitis has already been observed over a hundred years ago. In CT-confirmed uncomplicated acute diverticulitis (left-sided appendicitis), studies have shown no benefit from antibiotics compared with symptomatic treatment, but this shift from antibiotics to symptomatic treatment has not yet been widely implemented in clinical practice. Recently, symptomatic treatment of uncomplicated acute appendicitis has been demonstrated in a Korean open-label study. However, a double-blinded placebo-controlled study to illustrate the role of antibiotics and spontaneous resolution of uncomplicated acute appendicitis is still lacking. METHODS AND ANALYSIS The APPAC III (APPendicitis ACuta III) trial is a multicentre, double-blind, placebo-controlled, superiority randomised study comparing antibiotic therapy with placebo in the treatment CT scan-confirmed uncomplicated acute appendicitis aiming to evaluate the role of antibiotics in the resolution of uncomplicated acute appendicitis. Adult patients (18-60 years) with CT scan-confirmed uncomplicated acute appendicitis (the absence of appendicolith, abscess, perforation and tumour) will be enrolled in five Finnish university hospitals.Primary endpoint is success of the randomised treatment, defined as resolution of acute appendicitis resulting in discharge from the hospital without surgical intervention within 10 days after initiating randomised treatment (treatment efficacy). Secondary endpoints include postintervention complications, recurrent symptoms after treatment up to 1 year, late recurrence of acute appendicitis after 1 year, duration of hospital stay, sick leave, treatment costs and quality of life. A decrease of 15 percentage points in success rate is considered clinically important difference. The superiority of antibiotic treatment compared with placebo will be analysed using Fisher's one-sided test and CI will be calculated for proportion difference. ETHICS AND DISSEMINATION This protocol has been approved by the Ethics Committee of Turku University Hospital and the Finnish Medicines Agency (FIMEA). The findings will be disseminated in peer-reviewed academic journals. TRIAL REGISTRATION NUMBER NCT03234296; Pre-results.
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Affiliation(s)
- Suvi Sippola
- Division of Digestive Surgery and
Urology, Turku University Hospital, Turku, Finland
- Department of Surgery,
University of Turku, Turku, Finland
| | - Juha Grönroos
- Division of Digestive Surgery and
Urology, Turku University Hospital, Turku, Finland
- Department of Surgery,
University of Turku, Turku, Finland
| | - Ville Sallinen
- Department of Surgery,
Helsinki University Central Hospital, Helsinki, Finland
| | - Tero Rautio
- Department of Surgery,
Oulu University Hospital, Oulu, Finland
| | - Pia Nordström
- Division of Surgery, Gastroenterology and
Oncology, Tampere University Hospital, Tampere, Finland
| | - Tuomo Rantanen
- Department of Surgery,
Kuopio University Hospital, Kuopio, Finland
| | - Saija Hurme
- Department of Biostatistics,
University of Turku, Turku, Finland
| | - Ari Leppäniemi
- Department of Surgery,
Helsinki University Central Hospital, Helsinki, Finland
| | | | - Johanna Laukkarinen
- Division of Surgery, Gastroenterology and
Oncology, Tampere University Hospital, Tampere, Finland
| | - Heini Savolainen
- Department of Surgery,
Kuopio University Hospital, Kuopio, Finland
| | - Johanna Virtanen
- Department of Radiology,
Turku University Hospital, Turku, Finland
| | - Paulina Salminen
- Division of Digestive Surgery and
Urology, Turku University Hospital, Turku, Finland
- Department of Surgery,
University of Turku, Turku, Finland
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Quadri R, Vasan V, Hester C, Porembka M, Fielding J. Comprehensive review of typical and atypical pathology of the appendix on CT: cases with clinical implications. Clin Imaging 2018; 53:65-77. [PMID: 30316106 DOI: 10.1016/j.clinimag.2018.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/13/2018] [Accepted: 08/22/2018] [Indexed: 12/14/2022]
Abstract
Acute appendicitis is the most common abdominal surgical emergency in the United States with approximately 250,000 cases annually. Computed Tomography (CT) has emerged as the most accurate diagnostic test to triage these patients for emergent surgery. Although the radiology search pattern is prioritized to detect an inflamed appendix, not all appearances equate to a typical surgical appendicitis. There are a select set of atypical pathologies involving the appendix that have subtle differences on CT, but can have catastrophic complications if treated with emergent appendectomy. This paper will review the spectrum of CT appearances and clinical management for typical and atypical appendiceal pathologies.
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Affiliation(s)
- Rehan Quadri
- University of Texas Southwestern Department of Radiology, United States of America.
| | - Vasantha Vasan
- University of Texas Southwestern Department of Radiology, United States of America
| | - Caitlin Hester
- University of Texas Southwestern Department of Surgery, United States of America
| | - Matthew Porembka
- University of Texas Southwestern Department of Surgery, United States of America
| | - Julia Fielding
- University of Texas Southwestern Department of Radiology, United States of America
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Low-dose CT for the diagnosis of appendicitis in adolescents and young adults (LOCAT): a pragmatic, multicentre, randomised controlled non-inferiority trial. Lancet Gastroenterol Hepatol 2017; 2:793-804. [PMID: 28919126 DOI: 10.1016/s2468-1253(17)30247-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 07/18/2017] [Accepted: 07/21/2017] [Indexed: 01/04/2023]
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