Acute appendicitis in adults: only clinical and laboratory diagnostics, only imaging, or both?

Abstract

The presented article is devoted to the discussion of the necessity and expediency of using medical visualization diagnostics — radiological imaging — of acute appendicitis as an independent or complex approach in combination with clinical and laboratory data. Until now, the clinical diagnosis of each individual case of acute appendicitis is complicated, and its formulation requires combining clinical, laboratory and imaging data, since it includes a wide range of differential diagnoses depending on age and gender. The literature provides data that the frequency of negative appendectomies based on the results of a clinical examination can be up to 28.2%. Radiological imaging is used as an adjunct to clinical diagnostics using ultrasound examination, computed tomography and magnetic resonance imaging, but the role of the latter is limited by the duration of the study, increased cost, unavailability around the clock, as well as the presence of absolute contraindications. Sonography and computed tomography in diagnostics have a number of advantages and disadvantages, and the question of choosing a specific method still causes scientific controversy. We also provide illustrative clinical examples demonstrating echographic and computed tomographic imaging manifestations of acute appendicitis, as well as discuss visualization signs. For a patient with suspected acute appendicitis, in order to increase the accuracy of diagnosis, reduce complications or the need of undergoing unnecessary diagnostic and therapeutic procedures, a multidisciplinary and multimodal approach is necessary, taking into account age, gender and constitution, however, the question of choosing the optimal method of medical imaging in the diagnosis of acute appendicitis between ultrasound and computed tomography remains debatable.