Ultrasound could precede CT in acute appendicitis triage

Color Doppler ultrasound, not CT, should be the first imaging modality for triage of adult patients with suspected acute appendicitis, according to a study from Israel.

Dr. Diana Gaitini and colleagues at the Rambam Health Care Campus and the Technion-Israel Institute of Technology, both in Haifa, reviewed the medical records of 420 consecutive patients who presented to the ER with clinically suspected acute appendicitis. Patients underwent sonography of the right upper abdomen and pelvis and Doppler ultrasound of the right lower quadrant; 132 patients with inconclusive clinical or ultrasound results also underwent CT. Although color Doppler ultrasound missed the diagnosis in 23 patients, it correctly ruled out acute appendicitis in 312 of 326 negative cases (AJR 2008;190:1300-1306).