Valor do diagnóstico ultra-sonográfico da apendicite aguda

Abstract

The acute appendicitis diagnosis has always been based on clinical history and physical examination. Ultrasonographic examination is used to clarify unusual clinical aspects reducing unnecessary appendicectomies and progression of the disease. The current study objectives are to verify the ultrasonographic examination value for the diagnosis of acute appendicitis and the influence of factors such as patients gender and physical constitution by analyzing the body mass index (BMI), radiologists experience and the disease evolution span. Ahundred and fifty six patients (156) with diagnosis of acute appendicitis were prospectively evaluated and underwent ultrasonographic examination and appendicectomy by video laparoscopy with anatomopathologic study of extirpated parts. The patients were divided in two groups based on BMI: below and above 25 Kg/m². The disease progression time was measured in hours. The radiologists professional experience was divided in three categories: below 5 years, between 5and 10 years and above 10 years. Anatomopathology confirmed the diagnosis of acute appendicitis in 131 patients (83.9%). Ultrasonographic examination for acute appendicitis revealed 64.9% of sensibility and 72% of specificity with a positive predictive value of 92.4% and a negative predictive value of 28.1%. There was no significant difference between patients with BMI below or above 25 Kg/m², neither between the three categories of radiologists experience. The ultrasonographic examination had no influence concerning the disease progression time (median of 36 hours) or patients gender. The conclusions are that ultrasonography is a poor contribution for the acute appendicitis diagnosis and that the body mass index, patients gender, radiologists experience and the disease progression had no influence in the results.