Can Ultrasound Compete With CT in Evaluation of Possible Appendicitis?

John P. McGahan, MD


Appl Radiol. 2002;31(3) 

In This Article


Appendicitis is one of the most common conditions in children and adults.[1,2] In most situations, signs and symptoms can establish the diagnosis reliably. Patients usually present with periumbilical pain that later localizes to the right lower quadrant (RLQ) at McBurney's point. In most cases, pain is accompanied by mild anorexia and nausea or vomiting. In a recent series, the combination of abdominal pain and tenderness accompanied by leukocytosis >12,000 cells/mm3 had the highest predictive value for acute appendicitis.[2,3] However, in some patients there is a delay in diagnosis resulting in increased risk of perforation, sepsis, and even death. In a recent series of childhood appendicitis, all 10 patients younger than 10 years of age had a perforated appendix at the time of operation. In 35 children between 1 and 5 years of age with appendicitis, there was a perforation rate of 69%.[2] Recent series have demonstrated a 19.8% morbidity rate among patients with perforated appendicitis.[3]

The surgical literature has accepted that up to 25% of patients undergoing appendectomy will have a normal appendix.[4] This is the so-called negative appendectomy rate. Therefore, the goal of any further studies would be threefold. The first goal would be to diagnose appendicitis promptly in hope of reducing the rate of perforation and associated complications. The second goal would be to reduce the number of patients undergoing unnecessary removal of a normal appendix. After exclusion of appendicitis, the final goal would be to establish the etiology of the patient's RLQ pain.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.