Opacificação da gordura periapendicular como sinal tomográfico específico de apendicopatias inflamatórias e não inflamatórias

Abstract

BACKGROUND: Appendicopathies persist as a diagnostic challenge despite advances in imaging studies, with morphologically normal appendices being removed in more than 20% of appendenctomies. OBJECTIVE: To investigate the association between clinical parameters, periappendiceal fat stranding in computed tomography (CT) exams and histopathological findings of inflammatory and non-inflammatory appendiceal diseases. METHODS: The project of this work was approved by the Research Ethics Committee of the Universidade de Ciências Sociais Aplicadas (CAAE 51272121.2.0000.5175), UNIFACISA. The data were collected from medical records of 200 patients of both genders aged 15 to 72 years who underwent appendectomy due to clinical diagnosis of acute appendicitis at the Regional Emergency and Trauma Hospital Dom Luiz Gonzaga Fernandes. All medical records included in this study were from patients who underwent abdominal CT. The variables studied were: age, gender, clinical signs and symptoms, laboratory tests, Alvarado score, periappendiceal fat stranding level on CT and histopathological findings. The adopted significance level was set at p ≤ 0.05. RESULTS: Sociodemographic, clinical, and laboratory data were not different from those described in other medical literature series. Lower levels of periappendiceal fat stranding (0 and 1) were associated with non-inflammatory appendicopathies, while higher levels (2 and 3) were related to inflammatory appendicopathies, with a sensitivity of 74% and specificity of 100%. Higher levels of periappendiceal fat stranding occurred in patients with inflammatory appendicopathies and Alvarado scores equal or higher than 7. These patients had a longer hospital stay. CONCLUSION: Periappendiceal fat stranding seen on CT scans allows the design of a reliable score for the accurate diagnosis of inflammatory appendiceal disease, with a high fat stranding index, or non-inflammatory disease, with a low fat stranding index. This score allows predicting therapeutic indications and the length of hospitalization.