Differentiation between right tubo-ovarian abscess and appendicitis using CT - A diagnostic challenge

I. Eshed, O. Halshtok, Z. Erlich, R. Mashiach, M. Hertz, M. M. Amitai, O. Portnoy, L. Guranda, N. Hiller, S. Apter

פרסום מחקרי: פרסום בכתב עתמאמרביקורת עמיתים


Aim: To determine CT features that can potentially differentiate right tubo-ovarian abscess (TOA) from acute appendicitis (AA; including abscess formation). Materials and methods: The abdominal computed tomography (CT) images of 48 patients with right-sided TOA (average age 39.3 ± 9.8 years) and 80 patients (average age 53.5 ± 19.9 years) with AA (24 with peri-appendicular abscess) were retrospectively evaluated. Two experienced radiologists evaluated 12 CT signs (including enlarged, thickened wall ovary, appendix diameter and wall thickness, peri-appendicular fluid collection, adjacent bowel wall thickening, fat stranding, free fluid, and extraluminal gas) in consensus to categorize the studies as either TOA or AA. The diagnosis and the frequency of each of the signs were correlated with the surgical and clinical outcome. Results: Reviewers classified 92% cases correctly (TOA = 85%, AA = 96.3%), 3% incorrectly (TOA = 6.3%, AA = 1.3%); 5% were equivocal (TOA = 8.3%, AA = 2.5%). In the peri-appendicular abscess group reviewers were correct in 100%. Frequent findings in the TOA group were an abnormal ovary (87.5%), peri-ovarian fat stranding (58.3%), and recto-sigmoid wall thickening (37.5%). An abnormal appendix was observed in 2% of TOA patients. Frequent findings in the AA group were a thickened wall (32.5%) and distended (80%) appendix. Recto-sigmoid wall thickening was less frequent in AA (12.5%). The appendix was not identified in 45.8% of the TOA patients compared to 15% AA. Conclusions: In the presence of a right lower quadrant inflammatory mass, peri-ovarian fat stranding, thickened recto-sigmoid wall, and a normal appearing caecum, in young patients favour the diagnosis of TOA. An unidentified appendix does not contribute to the differentiation between TOA and peri-appendicular abscess.

שפה מקוריתאנגלית
עמודים (מ-עד)1030-1035
מספר עמודים6
כתב עתClinical Radiology
מספר גיליון11
מזהי עצם דיגיטלי (DOIs)
סטטוס פרסוםפורסם - נוב׳ 2011

הערה ביבליוגרפית

Funding Information:
This study was supported by the National Institutes of Health (grant no. U19AI110818 awarded to P.C.S, grant no. KL2 TR001100 awarded to A.P., and grant no. R33AI129455 awarded to C.Y.C.), the Charles and Helen Schwab Foundation (grant awarded to C.Y.C.), and a Broadnext10 gift from the Broad Institute (awarded to P.C.S.).

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