The Value of Sonographic Evaluation of the Appendix in Patient with Pelvic Inflammatory Disease: Correlation with CT, clinical, and Pathological Findings

ABSTRACT

PURPOSE: To assess the sonographic evaluation of the appendix in patients with pelvic inflammatory disease (PID) using CT, clinical, and pathological comparisons. MATERIALS AND METHODS: During a three-year period, 51 patients with PID underwent appendix US and abdomino-pelvic CT. The findings of appendix on US were classified into three categories (normal appendix, normal appendix with inflamed periappendiceal fat, and acute appendicitis). Based on the CT analysis, the condition of the appendix was classified into five categories, namely ('normal, 'probably normal', 'equivocal CT findings for diagnosis of appendicitis', 'probable appendicitis', 'definite appendicitis'). The CT and US results were then correlate with clinical and pathological findings. RESULTS: Of 21 patients with definite or probable appendicitis as shown by CT analysis, US demonstrated normal appendix in 10 patients (48%), normal appendix with inflamed periappendiceal fat in 10 patients (48%), and primary appendicitis in the remaining patient (4%). Of 25 patients with normal or probably normal appendix as shown by CT analysis, US demonstrated normal appendix in 24 patients (96%), and primary appendicitis in the remaining patient (4%). The two patients with primary appendicitis, as shown by US, underwent appendectomy and pathological studies revealed primary appendicitis. CONCLUSION: A sonographic evaluation of the appendix in patients with PID improved the diagnostic accuracy for primary appendicitis.