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Diagnosing Acute Appendicitis in Adults: Accuracy of Color Doppler Sonography and MDCT Compared with Surgery and Clinical Follow-Up

Diana Gaitini1,2, Nira Beck-Razi1, David Mor-Yosef2, Doron Fischer1, Ofer Ben Itzhak2,3, Michael M. Krausz2,4 and Ahuva Engel1,2

1 Department of Medical Imaging, Rambam Health Care Campus, POB 9602, Haifa 31906, Israel.
2 The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
3 Department of Pathology, Rambam Health Care Campus, Haifa, Israel.
4 Department of Surgery A, Rambam Health Care Campus, Haifa, Israel.


Figure 1
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  		Fig. 1 —Sonography of normal appendix in 18-year-old woman with lower abdominal pain. On longitudinal scan, tubular blind-ended structure with thin walls and less than 5 mm outer diameter (arrows) is seen in right lower quadrant, anterior to external iliac vessels.

 

Figure 2
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  		Fig. 2 —28-year-old man with fever and right lower quadrant pain. Incompressible, blind-ended, fluid-filled tubular structure 6.6 mm in diameter with hyperemic walls (arrows), pathognomonic for acute appendicitis, is seen on color Doppler sonography.

 

Figure 3
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  		Fig. 3A —32-year-old woman with right lower quadrant tenderness. Axial sonography images obtained without compression (A) and during compression (B) show inflamed appendix with hypoechoic center, inner hyperechoic ring, and outer hypoechoic ring (target sign). Note hyperechoic surrounding area of inflamed mesentery fat (halo sign).

 

Figure 4
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  		Fig. 3B —32-year-old woman with right lower quadrant tenderness. Axial sonography images obtained without compression (A) and during compression (B) show inflamed appendix with hypoechoic center, inner hyperechoic ring, and outer hypoechoic ring (target sign). Note hyperechoic surrounding area of inflamed mesentery fat (halo sign).

 

Figure 5
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  		Fig. 4 —23-year-old woman with fever and lower abdominal pain. Sonography image shows fluid collection with thick internal septum in right lower quadrant (arrows), which raised suspicion of periappendicular abscess and was confirmed on surgery. Inflamed appendix was not seen.

 

Figure 6
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  		Fig. 5 —18-year-old woman with lower abdominal pain (same patient as in Fig. 1). CT image shows normal appendix. Intraluminal air is seen in less-than-5-mm diameter appendix (arrow), surrounded by normal mesenteric fat.

 

Figure 7
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  		Fig. 6 —20-year-old woman with periumbilical and lower right quadrant pain. Incompressible appendix, 4.2 mm in diameter (cursors), is seen on sonography. Iliac vessels are shown on color Doppler. Sonography report was inconclusive for acute appendicitis. Acute appendicitis was diagnosed on CT (not shown).

 

Figure 8
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  		Fig. 7 —40-year-old man with right lower abdominal pain. Retrocecal inflamed appendix (arrow) and surrounding blurred fat were seen on MDCT but were missed on sonography examination (not shown).

 

Figure 9
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  		Fig. 8A —26-year-old woman with fever and abdominal pains. Sonography image shows incompressible thickened wall structure in lower right quadrant (arrows), diagnosed by resident on duty as acute appendicitis.

 

Figure 10
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  		Fig. 8B —26-year-old woman with fever and abdominal pains. CT image shows pathologic terminal ileum (arrow) compatible with terminal ileitis. Normal appendix (arrowheads) is seen.

 

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