Ultrasound accurate for appendicitis in children

Ultrasound accurate for appendicitis in children

By AuntMinnie.com staff writers

February 11, 2014 -- Portable ultrasound is an excellent first-line choice for diagnosing appendicitis in children, according to an article published online February 10 in Academic Emergency Medicine.

Bedside ultrasound delivered a specificity of 94% and reduced the need for CT scans by more than a third, according to study co-author Dr. Ee Tein Tay, assistant professor of emergency medicine and pediatrics at the Icahn School of Medicine at Mount Sinai.

CT is the most accurate imaging modality for diagnosing appendicitis, but it delivers a potentially harmful radiation dose, particularly in children. As a result, efforts are underway to reduce the 4 million radiation-emitting scans given to children each year.

The prospective, observational study included 150 pediatric patients who were evaluated for suspected appendicitis between May 2011 and October 2012 in an urban pediatric emergency department.

Use of portable ultrasound reduced the CT scanning rate by more than 35% -- from a 44% rate before the study to 27% during the study.

In addition, the emergency department length of stay declined 46% (by two hours and 14 minutes) for those undergoing radiology department ultrasound. Length of stay decreased by 68% (almost six hours) for those who required CT after an initial point-of-care ultrasound was inconclusive.

No cases of appendicitis were missed with the use of first-line ultrasound, and no unnecessary surgeries were performed for a normal appendix.

Related Reading

AJR: Using ultrasound 1st for appendicitis saves money, January 14, 2014

Study: Use ultrasound 1st for appendicitis in kids, December 3, 2013

Teleradiology on mobile devices OK for appendicitis, November 4, 2013

ARRS: MRI tops US in appendicitis detection in pregnant women, April 22, 2013

MRI helps guide appendicitis assessment in pregnant women, April 2, 2013

Copyright © 2014 AuntMinnie.com

Last Updated np 2/10/2014 5:41:54 PM

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SHEAR WAVE ELASTOGRAPHY of LIVER FIBROSIS

Sonography is a noninvasive and inexpensive procedure for diagnosis of diffuse liver disease; however, the value of sonography for distinguishing a low degree of liver fibrosis from cirrhosis is limited. In a study by Colli et al, 28 of 107 patients with severe fibrosis or definite cirrhosis (26%) had negative results for liver surface nodularity and caudate lobe hypertrophy and had normal hepatic venous flow. In this regard, elastography integrated into ultrasound systems is an effective adjunctive tool for quantifying liverfibrosis.

Conclusions

In patients with chronic viral hepatitis, particularly in patients with hepatitis C virus infection, all noninvasive methods are ready to be used for detecting and staging liver fibrosis before therapy at a safe level of predictability.

As with transient elastography, elastographic techniques based on shear waves generated by the acoustic beam are more accurate in detecting cirrhosis than significant fibrosis. They have the advantage of B-mode guidance, which allows one to choose an area of liver parenchyma better suited for stiffness assessment (ie, free of large vessels and focal lesions).

These methods are all valid when information about fibrosis is needed. Liver biopsy should still be performed when biochemical tests and imaging studies are inconclusive or information other than liver fibrosis is required.