RESUMEN
OBJECTIVE: The objective of our study was to evaluate appendiceal involvement in Crohn's disease with gray-scale and color Doppler sonography and differentiate it from acute appendicitis. MATERIALS AND METHODS: Analysis of the sonographic examinations was performed over 5 years in 190 patients with an established diagnosis of Crohn's disease. Data analyzed were as follows: visualization of the appendix; thickness and color Doppler signal (grade 0, 1, or 2) of the appendix and adjacent intestinal loop (cecum, terminal ileum, or both); involvement of other intestinal segments; and abscesses. The findings were compared with those of 49 consecutive patients with sonographic findings of acute appendicitis. RESULTS: Thirty-nine patients with Crohn's disease (21%) had appendicular involvement. All but one patient showed thickening of the terminal ileum, and 46% of patients also showed thickening of the cecum. The thickness of the ileum was more than 5 mm (only the anterior wall) in 64% of patients. Appendicular hyperemia was seen in 72% of patients. Involvement of other segments was seen in 23 patients (59%) and adjacent abscesses in six (15%). Irregular thickness of the submucosa was seen in nine cases (23%) and fibrofatty proliferation in 19 (49%). In patients with ileocecal regional disease, ileum thickness of more than 5 mm and visible color in the ileum were the most valuable signs, both for the diagnosis of Crohn's disease and to differentiate it from acute appendicitis (positive predictive value, 96%; negative predictive value, 74%). CONCLUSION: Appendicular involvement in Crohn's disease is a relatively frequent event (21%). Sonography and color Doppler sonography may be useful for differentiating Crohn's disease with appendicular involvement from acute appendicitis.
Asunto(s)
Apendicitis/diagnóstico por imagen , Apendicitis/etiología , Apéndice , Enfermedades del Ciego/diagnóstico por imagen , Enfermedades del Ciego/etiología , Enfermedad de Crohn/complicaciones , Ultrasonografía Doppler en Color , Enfermedad Aguda , Adulto , Anciano , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The aim of this study was to compare the sensitivity and specificity of plain abdominal films plus ultrasound, vs nonenhanced CT for the diagnosis of ureteral colic in patients with acute flank pain. During a 4-month period, 66 patients (mean age 48 years) with acute flank pain were prospectively studied by means of plain abdominal film, US, and unenhanced CT. The presence of lithiasis and of obstructive uropathy signs were determined. The plain film was only used as a guide for the US exam. Clinical follow-up of all patients was obtained. Ureteral lithiasis was confirmed in 56 patients. The CT had a greater sensitivity (93 vs 79%) and negative predictive value (71 vs 46%) for the detection of lithiasis. The combination of lithiasis plus obstructive signs showed a sensitivity and a specificity of 100% for CT and of 100 and 90%, respectively, for US. The 11 lithiasis not detected by US were passed spontaneously (10 were <5 mm). Both techniques showed similar extraurinary pathology. Computed tomography is the most accurate technique for the detection of ureteral lithiasis; however, the combination of plain film and US is an alternative to nonenhanced CT with a lower sensitivity and radiation dose that has a good practical value.