Surgery Book

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CT Abdomen in Appendicitis

Aka: CT Abdomen in Appendicitis
  1. See Also
    1. Appendicitis
  2. Indications
    1. Suspected Appendicitis
  3. Technique
    1. Focused below lower pole of right Kidney
    2. CT Abdomen with IV contrast alone is sufficient in most cases
      1. Similar efficacy in Appendicitis diagnosis with IV contrast alone when compared with IV and Oral Contrast
      2. Oral Contrast may be indicated in thin patients (without adequate fatty tissue) or when abscess is suspected
      3. Drake (2014) Ann Surg 260(2):311-6 [PubMed]
  4. Interpretation
    1. Signs suggestive of Appendicitis
      1. Fat streaking
      2. Appendix exceeds 6 mm in diameter
      3. Fluid filled peripheral enhancing tubular structure
      4. RLQ inflammation and no normal appendix identified
      5. Appendix wall thickening
  5. Efficacy
    1. CT Abdomen is considered the preferred first-line study in evaluation of suspected Appendicitis
    2. Helical CT most accurate
      1. Test Sensitivity: >87%
      2. Test Specificity: >95%
      3. Accuracy: 93-98%
      4. Negative Predictive Value: 95%
      5. Fefferman (2001) Radiology 220:691-5 [PubMed]
    3. CT does not seem to improve diagnosis of Appendicitis
      1. Study finds that CT overall did not offer benefit
      2. Also CT prolonged emergency room and hospital stays
      3. CT with contrast may provide better accuracy
      4. Perez (2003) Am J Surg 185:194-7 [PubMed]

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