Abdus Sami Qazi.
Improving Sonographic Accuracy of Detecting Acute Appendicitis by Using Additional Criterion of Pinpoint Tenderness.
Proceeding Shaikh Zayed Postgrad Med Comp Jan ;22(2):101-6.

Objective: The purpose of this study was to determine the improvement in sonographic diagnostic accuracy in patients with suspected acute appendicitis in a tertiary care hospital, utilizing commercially available 3.75 MHz curved array probe and adding a new criterion of pinpoint tenderness to the already known sonographic criteria of acute appendicitis. Materials and methods: 64 patients, 28 males and 36 females (mean patient age 22.4 years) attending the Emergency Department Of Lahore General Hospital, Lahore, from January 2008 to December 2008, were evaluated by the author sonographically after they had been labeled as cases of acute appendicitis by the referring experienced surgeon. The center of the probe was placed at the point of maximal tenderness and a diagnosis of acute appendicitis was confirmed if inflamed appendix or periappcndiceal soft tissue inflammation was noted underneath this tender region. Clinical impression of acute appendicitis was refuted if neither enlarged appendix nor periappendiceal soft tissue hypercchogcnecity/localized fluid collection were noted on sonography. Results: Sonography confirmed the diagnosis in 56 out of 64 patients whereas 2 patients, falsely reported to be normal on sonography, were found to be having acute append icitis on surgery. False positive diagnosis was not made in any case. Sensitivity (96.5%) and specificity (! 00%) achieved in this study were higher than figures repo1ted in current studies (sensitivity of 77-89% and specificity of 94-96%) where reliance has been made on known sonographic features of acute appendicitis without carefully evaluating the site of maximal tenderness. Conclusion: A careful search for inflamed appendix or other signs of acute appendicitis by ultrasound underneath point of maximal tenderness in right iliac fossa can significantly improve diagnostic accuracy and should be encouraged so that a sizeable portion of unnecessary appendectomies can be avoided.

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