Appendiceal imaging: which test is best?

Radiologic imaging has been clearly shown to be useful for the evaluation of patients clinically suspected of having appendicitis with CT and ultrasound being the most frequently recommended modalities. However, controversy still exists as to which modality is the technique of choice for appendiceal imaging. Our experience has led us to conclude that a standard helical abdominopelvic CT is the initial test of choice for the evaluation of the adult patient suspected of having acute appendicitis. Focused appendiceal CT with colonic contrast is then utilized as a problem solving technique for equivocal cases after this initial assessment.

Correlation between presumed sinusitis-induced pain and paranasal sinus computed tomographic findings.

BACKGROUND: The correlation between facial and/or head pain in patients clinically suspected of having sinusitis and actual localized findings on sinus computed tomographic (CT) imaging are poorly understood. OBJECTIVE: To prospectively evaluate the relationship of paranasal sinus pain symptoms with CT imaging. METHODS: Two hundred consecutive patients referred by otolaryngologists and internists for CT of the paranasal sinuses participated by completing a questionnaire immediately before undergoing CT. Three radiologists blinded to the patients' responses scored the degree of air/fluid level, mucosal thickening, bony reaction, and mucus retention cysts using a graded scale of severity (0 to 3 points). The osteomeatal complexes and nasolacrimal ducts were also evaluated for patency. Bivariate analysis was performed to evaluate the relationship between patients' localized symptoms and CT findings in the respective sinus. RESULTS: One hundred sixty-three patients (82%) reported having some form of facial pain or headache. The right temple/forehead was the most frequently reported region of maximal pain. On CT imaging the maxillary sinus was the most frequently involved sinus. Bivariate analysis failed to show any relationship between patient symptoms and findings on CT. Patients with a normal CT reported a mean 5.88 sites of facial or head pain versus 5.45 sites for patients with an abnormal CT. CONCLUSIONS: Patient-based responses of sinonasal pain symptoms fail to correlate with findings in the respective sinuses. CT should therefore be reserved for delineating the anatomy and degree of sinus disease before surgical intervention.