Debnath Jyotindu, George R A, Ravikumar R
Professor, Department of Radiodiagnosis, Armed Forces Medical College, Pune 411040, India.
Senior Adviser (Radiodiagnosis), Command Hospital (Air Force), Bengaluru, India.
Med J Armed Forces India. 2017 Jan;73(1):74-79. doi: 10.1016/j.mjafi.2016.02.005. Epub 2016 Mar 29.
Acute appendicitis (AA) is the commonest cause of pain abdomen requiring surgical intervention. Diagnosis as well as management of acute appendicitis is mired in controversies and contradictions even today. Clinicians often face the dilemma of balancing negative appendectomy rate and perforation rate if the diagnosis is based on clinical scoring alone. Laboratory results are often non-specific. Imaging has an important role not only in diagnosing appendicitis and its complication but also suggesting alternate diagnosis in appropriate cases. However, there is no universally accepted diagnostic imaging algorithm for appendicitis. Imaging of acute appendicitis needs to be streamlined keeping pros and cons of the available investigative modalities. Radiography has practically no role today in the diagnosis and management of acute appendicitis. Ultrasonography (USG) should be the first line imaging modality for all ages, particularly for children and non-obese young adults including women of reproductive age group. If USG findings are unequivocal and correlate with clinical assessment, no further imaging is needed. In case of equivocal USG findings or clinico-radiological dissociation, follow-up/further imaging (computed tomography (CT) scan/magnetic resonance imaging (MRI)) is recommended. In pediatric and pregnant patients with inconclusive initial USG, MRI is the next option. Routine use of CT scan for diagnosis of AA needs to be discouraged. Our proposed version of a practical imaging algorithm, with USG first and always has been incorporated in the article.
急性阑尾炎（AA）是需要手术干预的腹痛最常见原因。即使在今天，急性阑尾炎的诊断和治疗仍存在诸多争议和矛盾。如果仅基于临床评分进行诊断，临床医生常常面临着平衡阴性阑尾切除率和穿孔率的两难境地。实验室检查结果往往缺乏特异性。影像学不仅在诊断阑尾炎及其并发症方面发挥着重要作用，还能在适当的病例中提示其他诊断。然而，目前尚无普遍接受的阑尾炎诊断成像算法。急性阑尾炎的成像需要根据现有检查方法的利弊进行简化。如今，X线摄影在急性阑尾炎的诊断和治疗中几乎没有作用。超声检查（USG）应作为各年龄段的一线成像方式，尤其适用于儿童和非肥胖的年轻成年人，包括育龄期女性。如果超声检查结果明确且与临床评估相符，则无需进一步成像检查。如果超声检查结果不明确或临床与影像学表现不一致，建议进行随访/进一步成像检查（计算机断层扫描（CT）或磁共振成像（MRI））。对于初始超声检查结果不确定的儿科和孕妇患者，MRI是下一个选择。应避免常规使用CT扫描来诊断急性阑尾炎。我们提出的实用成像算法版本，以超声检查为先且始终如此，已纳入本文。
