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Journal Articles Insights into Imaging Year : 2016

How to diagnose acute appendicitis: ultrasound first


Acute appendicitis (AA) is a common abdominal emergency with a lifetime prevalence of about 7 %. As the clinical diagnosis of AA remains a challenge to emergency physicians and surgeons, imaging modalities have gained major importance in the diagnostic work-up of patients with suspected AA in order to keep both the negative appendectomy rate and the perforation rate low. Introduced in 1986, graded-compression ultrasound (US) has well-established direct and indirect signs for diagnosing AA. In our opinion, US should be the first-line imaging modality, as graded-compression US has excellent specificity both in the paediatric and adult patient populations. As US sensitivity is limited, and non-diagnostic US examinations with non-visualization of the appendix are more a rule than an exception, diagnostic strategies and algorithms after non-diagnostic US should focus on clinical reassessment and complementary imaging with MRI/CT if indicated. Accordingly, both ionizing radiation to our patients and cost of pre-therapeutic diagnosis of AA will be low, with low negative appendectomy and perforation rates.

Dates and versions

hal-01734874 , version 1 (15-03-2018)



Gerhard Mostbeck, E. Jane Adam, Michael Bachmann Nielsen, Michel Claudon, Dirk Clevert, et al.. How to diagnose acute appendicitis: ultrasound first. Insights into Imaging, 2016, 7 (2), pp.255 - 263. ⟨10.1007/s13244-016-0469-6⟩. ⟨hal-01734874⟩
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