Imaging and intervention in patients with acute right lower quadrant disease.
US using graded compression plays a central role in the diagnostic work-up of acute right lower quadrant disease, but its results should always be integrated with clinical data and results of other possible radiological examinations. Direct US visualization of an inflamed appendix is solid proof of appendicitis. Pitfalls are secondary enlargement in perforated peptic ulcer, caecal carcinoma or Crohn's disease. If a normal appendix is visualized in its full length, appendicitis can be excluded. However, this is rarely the case. In practice, the only means to exclude appendicitis is to demonstrate an alternative condition, which in most cases is possible by US alone. Concomitant adynamic ileus is a valuable US finding. Abscesses related to appendicitis, Crohn's disease and colonic carcinoma respond well to percutaneous drainage, which is technically possible in 95% of cases. Some of these abscesses evacuate spontaneously to neighbouring bowel. For abscesses due to caecal diverticulitis spontaneous evacuation to the caecal lumen is the rule. For indication and drainage strategy, integration of US, CT and clinical data are indispensable. The use of US in right lower quadrant disease will not only lead to a strong improvement of diagnostic accuracy, but also to better understanding of the incidence and natural course of various conditions such as abortive appendicitis, appendiceal abscess, caecal diverticulitis, bacterial ileocaecitis and right-sided segmental infarction of the omentum.
Puylaert
J B
JB
Department of Diagnostic Radiology, Westeinde Hospital, The Hague, The Netherlands.
D000208:Acute Disease; D001064:Appendicitis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis; D015642:Radiology, Interventional; D014463:Ultrasonography