07 Jun

The role of radiological imaging in the diagnosis of acute appendicitis: COLOUR DOPPLER SONOGRAPHY Part 2

COLOUR DOPPLER SONOGRAPHYSome of the criteria for the diagnosis of appendicitis with the use of CT are similar to those for diagnosis with the use of ultrasonography, including appendiceal dilation, wall thickening and appendicolithiasis. Periappendiceal changes are more readily identified by CT and include blurred pericecal fat, mesenteric fat stranding, phlegmon, abscess, abnormal collections of air and fluid accumulations. Inflammatory thickening of the wall of the cecum is also often seen, and gives the appearance of an arrowhead or of a ‘cecal bar’ when the cecum is opacified by contrast material. You will always find best quality drugs ever, because now you can enjoy your shopping every time you need cheap asthma medications with a nice discount and delivery straight to your home, being sure this is the exact treatment your condition requires.

It is not possible to assess the compressibility or motility of the appendix, but the ability of the appendix to fill with enteric contrast material can be evaluated by CT. This is most rapidly and effectively done using rectal contrast agents. The alternative use of oral contrast material is more time consuming (by at least 30 to 60 min) and is limited by nausea, vomiting and disturbance of gastrointestinal motility. Failure to use enteric contrast material substantially reduces the ease of interpretation of the images, because the inflamed appendix might easily be mistaken for a loop of distal ileum. The use of intravenous contrast material introduces more risk, but it can reveal increased blood flow in the wall of the inflamed appendix or in periappendiceal tissues, and may be especially useful in thin patients (whose internal organs are not well separated by abdominal fat) and in those with periappendiceal abscesses. The relative merits of various contrast materials have been extensively debated.

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