Historically, the diagnosis of appendicitis has been made based on clinical findings. Diagnostic imaging has been used primarily to evaluate patients who have an atypical clinical presentation. Over the past several years, improvements in imaging technology have contributed to an increase in diagnostic accuracy in these patients.
Ultrasound has been suggested and used as the primary diagnostic imaging modality to evaluate for appendicitis. However, sonography is known to be highly operator dependent; large patient habitus and atypical appendiceal location are additional factors that may reduce the reliability of a negative sonographic examination for appendicitis.
CT is more accurate than ultrasound in the diagnosis of acute appendicitis. When dedicated CT examination of the appendix is performed to evaluate all patients with clinically suspected appendicitis, the diagnostic accuracy is 98%.
Early and accurate diagnosis of appendicitis can decrease patient morbidity and hospital costs by reducing the delay in diagnosis of appendicitis and its associated complications, as well as by avoiding inpatient observation prior to surgery in patients who present with atypical symptoms. Furthermore, both CT and ultrasound may rapidly provide alternative diagnoses which can be treated on an outpatient basis.
This teaching program can be accessed over the internet at: http://lunis.luc.edu/radiology/Appendicitis
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