Abdominal computed tomography during pregnancy for suspected appendicitis: a 5-year experience at a maternity hospital.

The objective of this article is to evaluate the role of computed tomography (CT) in a pregnant patient with right lower quadrant pain in whom there was a clinical suspicion of acute appendicitis. During a 5-year period the clinical records of all pregnant women who underwent imaging examination for clinically suspected appendicitis were reviewed. The imaging findings were correlated with patient management and final outcome. Thirty-nine pregnant patients were referred for imaging, of which 35 underwent initial evaluation with sonography, 23 of these women underwent a computed tomographic examination, and an additional 4 patients were directly imaged with CT without earlier sonographic assessment. Surgery confirmed appendicitis in all 5 patients who were operated on on the basis of findings of appendicitis on a CT scan. Two patients underwent surgery based on an alternate diagnosis suggested preoperatively (tubal torsion = 1, ovarian torsion = 1). All patients with negative findings at CT had an uneventful clinical course. In those patients who were evaluated only with ultrasound, a diagnosis of appendicitis was missed in 5 patients. The sensitivity of CT in the diagnosis of appendicitis in our study group was 100%, compared with a sensitivity of 46.1% for ultrasound. CT provides an accurate diagnosis in patients suspected to have acute appendicitis and is of value in avoiding false negative exploratory laparatomy with its consequent risk of maternal and fetal mortality and morbidity. Although sonography is the preferred initial imaging modality as its lack of ionizing radiation, CT is more accurate in providing a timely diagnosis and its use is justified to reduce maternal mortality and mortality in patients with appendicitis.

Sonographic evaluation of isolated abnormal axillary lymph nodes identified on mammograms.

OBJECTIVE: To evaluate the role of sonography in evaluation of abnormal axillary lymph nodes identified in patients with otherwise negative or benign findings on mammography. METHODS: For 3 years 2 months, we retrospectively reviewed 30 consecutive cases that had undergone sonographic evaluation for abnormal axillary lymph nodes identified in patients whose mammograms had an American College of Radiology Breast Imaging Reporting and Data System final assessment of 1 or 2. Mammographic and sonographic features of the lymph nodes were analyzed and correlated with the histologic diagnosis in patients undergoing biopsy. Patients who did not undergo biopsy had clinical or imaging follow-up. RESULTS: Twenty of the 30 patients studied had an abnormal sonographic appearance. Biopsy was recommended in 17 of the 20 patients on the basis of an abnormal sonographic appearance. In the remaining 3 patients, there was an underlying cause for lymphadenopathy, and these patients underwent clinical and sonographic follow-up. Eighteen patients underwent biopsy, including 1 patient with normal findings on sonography. Ten of these patients had malignant histologic findings: 6 were metastatic adenocarcinoma; 1, poorly differentiated sarcoma, and 3, lymphoma. The remaining 8 patients had benign histologic findings. The nonbiopsy group had clinical and or imaging follow-up (mean, 17.6 months; range, 6-25 months). The sensitivity (true-positive/true-positive + false-negative) of sonography for assessment of suspected abnormal lymph nodes in the patients studied was 100% (10 of 10); specificity (true-negative/true-negative + false-positive), 50% (10 of 20); positive predictive value (true-positive/true-positive + false-positive) for malignancy based on the presence of 2 or more abnormal sonographic features, 50% (10 of 20); and negative predictive value, 100%. CONCLUSIONS: Sonography is useful in further characterization of isolated abnormal axillary lymph nodes identified on mammography. Sonographic evaluation helps improve the specificity of imaging evaluation in assessment of these lymph nodes.