Clinical outcomes following identification of tip appendicitis on ultrasonography and CT scan
*Briana Leung, *Nikhil Madhuripan, *Katharine Bittner, *Vida Rastegar, David Tashjian, Kevin Moriarty, *Stanley Polansky, Michael Tirabassi
Baystate Medical Center, Springfield, MA
Objective: To determine whether ultrasound or CT findings of tip appendicitis truly correlate with a pathologic diagnosis of appendicitis.
Design: Retrospective cohort study.
Setting: Academic medical center, major referral hospital.
Patients: Our radiology database was mined for reports with a diagnosis of tip appendicitis between January 2013 and June 2017. The criteria for diagnosis were enlarged tip ≥6mm with remainder of appendix of normal caliber, and findings including free fluid, wall thickening, hyperemic vascularity, appendicoliths and non-compressibility. Exclusion criteria included obvious signs of complicated appendicitis on imaging such as phlegmon or abscess. 102 patients met inclusion criteria; 56 of whom were pediatric patients (<18 years old).
Main Outcome Measures: To determine what proportion of patients had appendiceal disease that was appropriate to manage with surgery. Patients managed nonoperatively (without antibiotics) and those with negative pathology were considered to not have appendicitis. Secondary measures included demographic and clinical data, and clinical outcomes. Fisher’s exact test (alpha < 0.2) was used to evaluate associations between certain factors and a diagnosis of appendicitis.
Results: 73 (71.6%) patients with tip appendicitis on ultrasonography or CT ultimately did not have appendicitis. 46 patients underwent appendectomy; 29 (63%) of whom had pathologic evidence of appendicitis. 4 patients managed nonoperatively required readmission, but not secondary to a missed diagnosis of appendicitis. Subjective RLQ pain (p=0.023), presence of RLQ tenderness to palpation (p=0.012), and elevated CRP (p=0.013) were associated with a pathologic diagnosis of appendicitis.
Conclusions: Ultrasound and CT findings of tip appendicitis should be considered an equivocal finding, and not solely diagnostic of appendicitis. Clinical judgment can dictate appropriate management since typical clinical signs and symptoms of appendicitis correlated with the diagnosis.
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