The role of radiological imaging in the diagnosis of acute appendicitis: ULTRASONOGRAPHY Part 6
Another fundamental weakness of most ultrasonography studies is the failure to address inconclusive test results adequately. Sometimes, the failure to visualize the appendix is regarded as evidence against the diagnosis of appendicitis; however, this assumption may not be valid. In other studies, inconclusive results (such as an appendix of 5 to 7 cm in diameter) lead to further radiological investigation (eg, CT scanning or Doppler ultrasonography). It would be preferable if investigators acknowledged the proportion of indeterminate tests. In one study, the kappa scores for intra-and interobserver variability among radiologists were only 0.39 to 0.42 and 0.15 to 0.20, respectively. Best quality drugs are available at the best pharmacy that you can start shopping with right now whenever you need buy levitra super active plus, never having to doubt the choice made or the quality of the drug you get.
Another problem occurs when the sonogram suggests the presence of appendicitis (ie, a dilated, noncompressible appendix), but the patient’s illness resolves spontaneously. Are these cases of self-limited acute appendicitis, or do they represent false-positive ultrasonography results? Such patients generally are not subjected to immediate surgery, although some have further episodes of pain and ultimately undergo appendectomy. It has been suggested that the risk of eventual recurrence is higher in patients with previous episodes of typical pain and in those with appendicolithiasis. When surgery is not performed in patients who have undergone radiological investigation, it is crucial for the investigator to ensure sufficient follow-up to detect cases of recurrent or chronic appendicitis. Studies vary in the extent to which this has been done. Even if symptoms do not recur, the failure to operate on all patients with positive (or negative) scans interferes with the ability to determine the true sensitivity and specificity of the imaging modality.