Acute Appendicitis: Correlation between Ultrasonographic and Surgical Findings

The main aim of our study is to estimate sensitivity and specificity of Ultrasonography in identifying acute appendicitis in patients referred with symptoms of right iliac fossa pain and its role in the therapeutic management. Materials and methods This study was carried out in the department of Radiodiagnosis, Maharajahs Institute of Medical Sciences, Vizianagaram on Philips affiniti 70 Ultrasound machine using MHz transducer on a hundred patients who presented to surgical out patient department, with symptoms of right iliac fossa pain. They underwent ultrasonography and appendectomy followed by histopathological examination of the specimen. Obese persons (due to difficulty in imaging) and patients requiring emergent surgery were excluded from our study. Ultrasound was done in supine position and in left lateral oblique position, using graded compression technique. Results Out of the hundred patients selected in our study, 64 were male patients, of which 49 were diagnosed to have acute appendicitis and 36 were female, of which 25 were diagnosed to have acute appendicitis on USG.2 males and 2 females were diagnosed to have appendicular mass on USG. Maximum age was 67 years and minimum age was 3 years. Maximum number of patients were in the age range of 11-20 years. Based on the Alvarado value (more than 5 were taken to have appendicitis), 73 % were likely to have appendicitis. On USG, 74 patients were diagnosed to have acute appendicitis of which 73 were confirmed on histopathology. On histopathological examination of all the removed appendix specimens, 76 were diagnosed as acute appendicitis. Sensitivity of USG in diagnosing acute appendicitis in our study was 96.05 %. Specificity was 95.83 %. The positive predictive value of the study is 98.64 % and negative predictive value is 88.46 %. The most common position of appendix in our study was retro-caecal (78.20 %), followed by pelvic (16.66 %). Conclusion Ultrasound has high sensitivity and specificity for diagnosis of appendicitis and should suffice as the modality of choice whenever the appendix is identified. CT should be reserved for complicated cases in which the appendix is not identified or the presence or absence of perforation cannot be determined with ultrasound, and histopathology should remain as gold standard.