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The National Ribat University Faculty of Graduate Studies & Scientific Research Assessment of Ultrasound in Diagnosis of Ac

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The National Ribat University Faculty of Graduate Studies & Scientific Research Assessment of Ultrasound in Diagnosis of Ac The National Ribat University Faculty of Graduate Studies & Scientific Research Assessment of Ultrasound in Diagnosis of Acute Appendicitis in Khartoum State A Thesis Submitted for Partial Fulfillment of the Requirements of Master Degree in Medical Diagnostic Ultrasound By: Omayma Abdelmonim Osman Ahmed Supervised By: Dr.Elsir Ali Saeed Taha 2016 The National Ribat University Faculty of Graduate Studies & Scientific Research Assessment of Ultrasound in Diagnosis of Acute Appendicitis in Khartoum State A Thesis Submitted for Partial Fulfillment of the Requirements of Master Degree in Medical Diagnostic Ultrasound Submitted By:Omayma Abdelmonim Osman Ahmed Supervised By: Dr.Elsir Ali Saeed Taha 2016 قال تعالى : ي يي ي ي (َويِف اأْلَأر يض آََي ٌت لِّأل ُموقن َني ﴿٢٠﴾ َويِف أَنُفس ُك أم أَفَََل تُ أبصُروَن ﴿٢١﴾) سورة الذاريات I Dedication: To Mom Mrs. Suad Abdallah To dad Dr . Abdelmonim Osman To husband Dr. Murtada Tag elsir For endless support and love. II ACKNOWLEDGMENT I am grateful to many persons whom contributed and shared their memories and experiences for this work especially: My teacher and supervisor Dr. Elsir Ali Saeed ; a person who had a significant impact on my graduate career. Also many thank to Dr. mohammed Elfadil Mohammed for valuable interpretation, discussion and scientific guidance. Special thanks to Dr. Raja Ahmed Abou Raida who kindly gave suggestions, advices and knowledge. I am grateful to Dr. Babiker Ahmed Elmagli for big opportunities he has afforded me. I would like to thank Dr Arafat ; I will never forget the experiences he shared. To my beloved family for help, patience, and encouragement. I would not be who am I today without you all. III ملخص الدراسة هذه دراسةةم تقةةية م وتح م أجريت في تقةةيىةة ى بحري اليع مي، وتقةةيىةة ى أتنرتات اليع مي - وهما تقيى ات حكوت ات ك رات في وﻻيم الخرطوم- في ال يرة تن س يم ر 2015 إلى يناير 2016 اشيم ت النراسم ع ى 57 تريضـا تىي ها بإصابيهم باليهاب الزائنة الحاد، تم اخي ارهؤﻻء المرضى عىوائ ا ؛ بحقةةت تىةةخ ج ال رام الم نئي، مم تم الكىةةم ع هم بواسةةام جهات الموجاص فوة القةةوت م، فةرر الا ت ضرورة إجراء عم م جراح م لهم. إت الهنف تن هذه النراسم هو اخي ار دقم تىخ ج اليهاب الزائنة النوديم الحاد، بواسام جهات الموجاص فوة القوت م في وﻻيم الخرطوم. و قن تم جمع ال اناص، وتقن ها، وتح ها، بواسام برناتج الحزتم اﻹحقائ م ل ع وم اﻹجيماع م. لةن أظهرص هذه النراسةةةةةم أت عند المرضةةةةةى الذكور ي وة اﻹناث بنقةةةةة م 1.7 : 1 ، وأت تيوسةةةةةا أعمار المرضةةى 21 عاتا ، و تيوسةةا ال يرة تن بنايم ظهور اأعراض حيى وصةةول المرضةةى إلى المقةةيىةة ى 36 ساعم، وأت عند كرياص النم ال ضاء يمكن أت يكوت ضمن المنى الا عي عنن اليهاب الزائنة الحاد. و أظهرص النراسم وجود عﻻق م ب ن تنة ظهور أعراض المرض، وعند كرياص النم ال ضاء، ونظام نةاط ال ارادو المعروف عالم ا ل ية م القريري عنن اشي اه اليهاب الزائنة الحاد. )33( ب نت النراسةةةةةم أت أكار خواه اليهاب الزائنة تﻻحظم بواسةةةةةام جهات الموجاص فوة القةةةةةوت م، هي تيادة تة اس قارالزائنة أكار تن 6 ت ميراص، وعنم تغ رشةةةةةةك ها عنن الضةةةةةةغا ع ها، وعنم وجود حركم بها، وظهور عﻻتم الهنف في القةةورة المةاع م. وأت أكار العﻻتاص تﻻحظم في المرضةةى الحاصةة ن ع ى 7 و 8 نةاط ال ارادو هي: تيادة صةةةنى النهن الموجود حول الزائنة ، مم ت مع سةةةوائ حولها، ي ه وجود حقةةةاة داخ ها، فوجود مةت بالزائنة. وأت أكار العﻻتاص تىةةاهنة في المرضةةى الحاصةة ن ع ى 5 و6 نةاط ال ارادو هي تم ز ط ةاص جنار الزائنة، ي ه تيادة نىاط تنفق النم . أظهرص النيائج اﻹحقةةائ م ل يىةةخ ج ب هات الموجاص فوة القةةوت م أت نقةةت: النقم، والحقةةاسةة م، واليع ن ،والة مم الين ؤيم اﻹي اب م، والة مم الين ؤيم الق م كاﻻتي: %93، 92.7.%، %100، %100، %33.33 باليوالي . وأخ را أم يت النراسم أهم م و دقم تىخ ج الموجاص فوة القوت م ﻹليهاب الزائنة الحاد، وأت عنم تىخ ج الموجاص القوت م ﻹليهاب الزائنة ﻻ ين ي وجوده. IV Abstract: A prospective and analytic study was performed at largest governmental and teaching hospitals )North Khartoum and Umdurman hospitals) in Khartoum State during period from September 2015 to January 2016 The study includes randomly selected 57 patients with clinical suspension of acute appendicitis; all of them examined by graded compression ultrasound and surgeon decide to operate; so post surgery notes collected. The aim of current study is to assess the accuracy of this modality in diagnosis of acute appendicitis in Khartoum State. The data was collected, classified and analyzed by statistics package for social sciences (SPSS). The study finds that acute appendicitis occurs more in males (male to female ratio is 1.7:1) and young adults (mean age is 21 years). The mean duration of symptoms is 36 hours and white blood cells count can be within normal limits despite acute appendicitis. Also it shows direct linear relationship between duration of symptoms, white blood cells count and Alvarado score (Alvarado score is a well known international score that helps in clinical evaluation of suspected acute appendicitis patients) (33). The most noted ultrasound features are non compressible, a peristaltic appendix, with diameter more than 6 mm and target appearance in cross section. The most noted ultrasound features in patients with Alvarado score 7 and 8 are: echogenic pericecal fat, followed by peri appendicular fluid collection, then presence of appendicolith, and finally perforated tips. The most noted ultrasound features in patients with Alvarado score 5 and 6 are: distinct wall layers of appendix and increased Doppler activity. V The calculated accuracy, sensitivity , specificity , positive and negative predictive values of ultrasound examination in this study are 93%, 92.7%, 100%, 100%, 33.33% respectively. Finally, this study proves the importance and accuracy of ultrasound diagnosis of acute appendicitis, but normal ultrasound examination does not rule out the possibility of the disease. VI List of tables: page Table 2-1 Comparison of US and CT---------------------------------------------------25 Table 4-1 Calculated means for numerical variables----------------------------64 Table 4-2 Classification according to gender------------------------------------64 Table 4-3 Classification according to residence --------------------------------64 Table 4-4 Classification according to Alvarado score -------------------------65 Table 4-5 Classification according to clinical impression----------------------65 Table 4-6 Classification according to diameter of appendix ------------------65 Table 4-7 Classification according to non compressible appendix-----------66 Table 4-8 Classification according to absence peristalsis----------------------66 Table 4-9 Classification according to presence of appendicolith -------------66 Table 4-10 Classification according to distinct wall layers --------------------67 Table 4-11 Classification according to echogenic fat---------------------------67 Table 4-12 Classification according to fluid collection-------------------------67 Table 4-13 Classification according to target sign-------------------------------68 Table 4-14 Classification according to Doppler activity------------------------68 Table 4-15 Classification according to ultrasound diagnosis ------------------68 Table 4-16 Classification according to sonologists experience----------------69 Table 4-17 Classification according to post surgical notes---------------------69 Table 4-18 Classification according to perforation------------------------------69 Table 4-19 Cross-tabulation Alvarado score*diameter--------------------------70 Table 4-20 Cross-tabulation Alvarado score*incompressible------------------70 Table 4-21 Cross-tabulation Alvarado score*a peristalsis-----------------------71 Table 4-22 Cross-tabulation Alvarado score*appendicolith--------------------71 Table 4-23 Cross-tabulation Alvarado score*wall layers-----------------------72 Table 4-24 Cross-tabulation Alvarado score*echogenic fat--------------------72 VII Table 4-25 Cross-tabulation Alvarado score*fluid collection------------------73 Table 4-26 Cross-tabulation Alvarado score*target appearance---------------73 Table 4-27 Cross-tabulation Alvarado score*Doppler--------------------------74 Table 4-28 Cross-tabulation Alvarado score*US diagnosis--------------------74 Table 4-29 Cross-tabulation Alvarado score*perforation-----------------------75 Table 4-30 Cross-tabulation post surgery*US diagnosis------------------------75 Table 4-31 Cross-tabulation age ranges*Doppler*US diagnosis------------------76 VIII List of Figures: page Figure (2-1): Longitudinal image of acutely inflamed appendix --------------------31 Figure (2-2): Transverse scan of acutely inflamed appendix ----------------------- 32 Figure (2-3): Normal appendix ---------------------------------------------------------- 33 Figure (2-4): Suppurative appendicitis ------------------------------------------------- 34 Figure (2-5): Gangrenous appendicitis ------------------------------------------------- 35 Figure (2-6): Perforated appendix--------------------------------------------------------36 Figure (2-7): Periappendiceal abscess formation-------------------------------------- 36 Figure (2-8) :Phlegmonous appendicitis------------------------------------------------ 37 Figure (2-9): Suppurative appendicitis ------------------------------------------------- 38 Figure (2-10): Retrocecal appendicitis in 4-year-old girl ----------------------------42 Figure (2-11): Retrocecal appendicitis in 4-year-old child--------------------------- 43 Figure (2-12): Deep pelvic appendicitis in 8- year-old girl ------------------------- 43 Figure (2-13): Deep abdominal appendicitis in 4-year-old -------------------------- 44 Image gallery: ------------------------------------------------------------------------------
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