ABSTRACT
Background: Acute appendicitis is one of the most common abdominal surgical emergencies requiring accurate diagnosis. Itis characterized by obstruction of its lumen, leading to inflammation and finally perforation. To define its prognosis, choose anappropriate surgical procedure and to decide non-surgical treatment, the pre-operative diagnosis of perforated or non-perforatedappendicitis is very important.Aim of the Study: This study aims to analyze the diagnostic accuracy of computed tomography (CT) scan abdomen indifferentiating perforated from non-perforated appendicitis using histopathology as the final diagnosis.Materials and Methods: Aprospective, cross-sectional analytical study, wherein 85 patients diagnosed with acute appendicitisreferred to the radiological department for CT scan abdomen were included in the study. Patients aged between 15 and 70 yearswere included in the study. CT scan abdomen with and without contrast was performed on a Toshiba 64 Multislice CT scanner(Toshiba Medical Systems Corp., Tokyo, Japan) which was used for all the patients. All the CT scans were interpreted by the sameconsultant radiologists with a minimum of 5 years of experience. The radiological features for the diagnosis of non-perforatedacute appendicitis by CT were based on swollen appendix, thickened enhancing wall, and smudging of surrounding fat planes,whereas the radiological features for perforated appendicitis used were, with abscess formation, phlegmon, extraluminal air,extraluminal appendicolith, and focal defect in the appendicular wall. Histopathology of the specimen collected following surgerywas undertaken by the hospital consultant pathologist of more than 5-year experience.Observations and Results: Among the 85 patients included in this study for the analysis of CT scan abdomen features, therewere 57 (67.05%) males and 28 (32.94%) females with a male-to-female ratio of 2.03:1. The mean age of the patients was38.90 ± 6.70 years. The incidence of non-perforated appendicitis was 66/85 (77.64%) including males 44/85 (51.76%) andfemales 22/85 (25.88%). The incidence of perforated appendicitis was 19/85 (22.35%) and males were 12/85 (14.11%) and 7/85(8.23%) were female. Patients aged 15–45 years of both genders constituted to 63/85 (74.11%) of the total patients. Amongthese patients, presenting with non-perforated appendicitis was 51/85 (60%) and perforated appendicitis was 12/85 (14.11%).Conclusions: Multislice CT scan abdomen was considered as the modality of choice for acute appendicitis not only to confirmthe diagnosis but also it plays an important role in assessment of appendicular complication, particularly in the detection ofperforated appendix. Using one or more of the five radiological signs of CT scan abdomen to identify appendicular perforationraised the sensitivity significantly reaching 94.12%.
ABSTRACT
Background: In the recent past, cardiac computed tomography (CT) angiography is being performed for the diagnosis and treatment of coronary artery disease (CAD) and congestive heart failure. The differentiation of ischemic from non-ischemic cardiomyopathy, characterization of hypertrophic cardiomyopathy, and delineation of congenital heart defects are its primary diagnostic applications. Aim of the Study: The aim was to study the clinical applications of coronary CT angiography (CCTA) in patients with suspected CAD and identify factors that affect CCTA findings. Materials and Methods: Two hundred and fourteen patients diagnosed with CAD were included in the study. Patients aged between 36 and 76 years were included. Patients with chest trauma and prior thoracic surgery (coronary stenting or coronary artery bypass grafts) were excluded. Demographic data of the patients were recorded including age, gender, blood pressure, body mass index, smoking habits, intake of alcohol, previous history of angina, diabetes, and hypertension were recorded. The duration of symptoms was classified into five groups: <1 week, 1 week to 1 month, 1–3 months, 3–6 months, and more than 6 months. All the patients were investigated with lipid profile, serum creatinine, and blood glucose levels. All the patients were subjected to CCTA. The percentage of abnormal CCTA was observed and recorded. Abnormality of coronary arteries was expressed as atherosclerotic changes identified on CCTA scans, which is reflected in either an involvement of the right coronary artery (RCA), or the left coronary artery (LCA), or both of RCA and LCA. Significant coronary stenosis indicates that more than 50% lumen stenosis due to the presence of plaques was considered. Observations and Results: Two hundred and fourteen patients with diagnosed CAD were included in the study, aged between 36 and 76 years. The mean age was 56 ± 2.10 years. There were 153 (71.49%) males and 61 (28.50%) were female, with a male-to-female ratio of 3.44:1. The youngest patient was aged 37 years and the eldest patient was 75 years with a mean age of 56 ± 2.10 years. There were 114/214 (53.27%) patients with abnormal CCTA scans and among them 84/114 (73.68%) were male and 30/114 (26.31%) were female. The most common symptom of presentation was pain in the chest elicited in 139 (64.95%) of the patients in this study, followed by history of hypertension in 89 (41.58%) patients. It was observed that there was no significant difference in the percentage of abnormal CCTA findings between male and female patients (P = 0.19), (with P value taken as statistically significant at <0.05). Similarly, no significant difference was found between the sex (male/female) and duration of symptoms (P = 0.71). Conclusions: CCTA is a non-invasive, outpatient-based procedure suitable in patients without actionable CAD, obviating unnecessary invasive examination of coronary vessels. CT angiography findings are directly related to patient age and duration of symptoms, with increased abnormal findings reported in elderly population with the duration of symptoms more than 6 months. Moreover, there was a direct correlation between the involvement of coronary arteries and the patient age.