The role of computerized tomography in the diagnosis of acute appendicitis in patients with negative ultrasonography findings and a low Alvarado score

BACKGROUND
We aimed to identify the role of computerized tomography (CT) in the differential diagnosis of acute appendicitis in patients with a low Alvarado score and negative ultrasonography findings.
METHODS
Fifty-two cases who underwent appendectomy (December 2004-September 2008) were included. All patients had an Alvarado score of 4-6 together with negative ultrasonography findings; preoperative abdominal CT examination results were available in all patients. CT results were compared with intraoperative and pathological findings.
RESULTS
The mean age of the cases was 31±4 years (range 11 to 71 years). The mean Alvarado score was 4.9. CT results were in favor of acute appendicitis in 34 of 52 cases. Of these 34 patients, acute appendicitis was confirmed by pathological findings in 31, whereas acute appendicitis could not be confirmed in the remaining three cases (8.2%). In 15 of 18 cases without CT findings of appendicitis, intraoperative and pathological findings were also in agreement; however, the remaining three cases had acute appendicitis. Based on the results of the recent studies, sensitivity and specificity of CT in the diagnosis of acute appendicitis were 91.2% and 83.3%, respectively.
CONCLUSION
To avoid unnecessary appendectomies in suspected acute appendicitis cases with a low Alvarado score and negative ultrasonography findings, CT may be used as a complementary diagnostic tool.

Ultrasonografi bulgusu negatif ve Alvarado skoru düþük akut apandisit þüpheli olgularda bilgisayarlý tomografinin tanýdaki rolü

AMAÇ
Klinik muayenede Alvarado skoru düþük, ultrasonografi (US) bulgusu negatif olan, akut apandisit (AA) þüpheli olgularda bilgisayarlý tomografinin (BT) tanýya katkýsýný irdelemektir.
GEREÇ VE YÖNTEM
Aralýk 2004-Eylül 2008 tarihleri arasýnda AA ön tanýsý ile incelen ve Alvarado skoru düþük olan hastalar çalýþmaya alýndý. Bu hastalarda önce US incelemesi yapýldý. US bulgularý negatif olanlarýn karýn BT’si çekildi. BT çekilen ve ameliyat edilen 52 olguda, ameliyat ve patoloji sonuçlarý ile BT bulgularý karþýlaþtýrýldý.
BULGULAR
Olgularýn yaþ ortalamasý 31±4 yýl (daðýlým, 11-71) idi. Alvarado skor ortalamasý 4,9 (daðýlým, 4-6) idi. BT deðerlendirme sonuçlarý; 52 hastanýn 34’ü (%65,4) AA olarak deðerlendirilirken 18’inde (%34) AA yönünden patoloji bulunmadý. AA olarak deðerlendirilen 34 hastanýn 31’inde (%91,2) ameliyat ve patoloji bulgularýna göre AA saptandý, 3 olguda ise (%8,2) saptanmadý. BT’de AA olarak deðerlendirilmeyen 18 olgunun 15’inde (%83,3) ameliyat ve patoloji bulgularýnda AA saptanmazken, 3 olguda ise saptandý. Bu çalýþmada AA tanýsýnda BT’nin duyarlýlýðý %91,2, özgüllüðü %83,3 olarak bulundu.
SONUÇ
Alvarado skoru düþük, US bulgularý negatif akut apandisit þüpheli olgularda gereksiz apendektomiden kaçýnmak için yardýmcý taný yöntemi olarak BT’den yararlanýlabilinir.