Sonographic Study about Differential Diagnosis between Acute Appendicitis and Non-appendicitis in Appendices of Borderline Diameter.

Chung,  Hwan Hoon; Kim,  Yun Hwan; Kim,  Hong Won; Park,  Seung Cheol; Lee,  Eun Jeong; Chung,  Kyoo Byung; Suh,  Won Hyuck

Journal of Korean Society of Medical Ultrasound 2000;19(4): 257-263.

Hwan Hoon Chung, Yun Hwan Kim, Hong Won Kim, Seung Cheol Park, Eun Jeong Lee, Kyoo Byung Chung, Won Hyuck Suh

Department of Radiology, College of Medicine, Korea University.

Published online: January 1, 2001.

ABSTRACT

PURPOSE: To find out the sonographic criteria which can be effectively used to differentiate acute appendicitis from non-appendicitis in patients with appendices with borderline diameter(5-8mm). MATERIALS AND METHODS: Sixteen patients diagnosed as acute appendicitis, another 16 patients diagnosed as non-appendicitis were included in this study. They complained of RLQ pain and their appendices measured 5-8mm in diameter on sonogram. Features such as appendiceal wall thickness, presence or absence of air in appendiceal lumen, movability of tip of the appendix, compressibility of the appendix were evaluated on gray-scale sonogram and thereafter, presence or absence of color flow in the wall of the appendix was evaluated on color Doppler sonogram. RESULTS: Thickness of appendiceal wall is 2.98 +/- 0.77mm in acute appendicitis group and 1.73 +/- 0.44mm in non-appendicitis group (p < 0.05). When 2.5mm thickness of appendiceal wall is applied for diagnosis of acute ap-pendicitis, sensitivity is 81.3%, specificity is 87.5% and accuracy is 84.4%. With absence of air in appendiceal lumen, sensitivity is 93.8%, specificity is 68.8% and accuracy is 81.3%. With absence of movability of appendiceal tip, sensitivity is 87.5%, specificity is 50% and accuracy is 68.8%. With absence of compressibility of the appendix, sensitivity is 100%, specificity is 31.3% and accuracy is 65.6%. With color flow in appendiceal wall, sensitivity is 81.3%, specificity is 62.5% and accuracy is 71.9%. The above mentioned criteria show statistically significant difference between acute appendicitis and non-appendicitis groups (p < 0.05). CONCLUSION: When the diameter of the appendix measures 5-8mm on sonogram, evaluation of thickness of appendiceal wall, air in appendiceal lumen, movability of tip, compressibility and color flow in the wall will be helpful to diagnose the acute appendicitis with confidence.

Keywords: Appendix, US; Appendicitis