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217]
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110 K Gupta et al
All the patients were then subjected to ultrasound
examination of abdomen.
Based on plain X-ray films and sonographic findings
provisional diagnosis was made. The final diagnosis was
made on the basis of operative findings/therapeutic
response/histopathological/laboratory findings. Finally the
accuracy of plain X-ray film abdomen and ultrasonography
in evaluating patients with acute abdomen was
determined.
6.
RESULTS
Table I shows that acute cholecystitis, acute appendicitis,
acute pancreatitis, gynaecological pathologies and
amoebic liver abscess were accurately diagnosed by
ultrasonography, whereas radiographic accuracy was
highest in renal cases.
7.
8.
9.
10.
11.
12.
13.
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112 K Gupta et al
In the present study, plain X-ray film was diagnostic only
in 1 (12.50%) case out of 8 patients of appendicitis. The
result was comparable to the earlier study where it was
reported the appendicolith by plain abdominal x-ray films
in 7 to 14% patients of acute appendicitis(11).
Sonographic criteria for acute appendicitis include
visualization of a non compressible appendix with
maximum outer diameter >6 mm or visualization of an
appendicolith within an appendix of any size, quite
comparable with our study where in 5 out of 8 patients
non compressible appendix was visualized with average
outer diameter of 8.8 mm (Fig. II). Appendicolith was
visualized in 1 patient only . In 1 patient, localised well
circumscribed fluid collection was found, suggestive of
appendicular abscess. In 1 out of 8 patients, ultrasound
study was normal but acute appendicitis was diagnosed
at surgery. Out of 90 patients with clinically suspected
acute appendicitis, three patients were considered to
represent false negative sonographic diagnosis(12). In
our study 1 patient out of 8 suspected cases of appendicitis
which was considered to represent false negative
sonographic diagnosis was proved to be acute
appendicitis at operation. Thus, the predictive accuracy
of ultrasound was 83.3% and sensitivity was 100%,
comparable to the reported sensitivity in acute appendicitis
80 89%(13).
Fig. No. 3
(i) X-ray abdomen showing dilated gut with significant air
fluid level
(ii) Ultrasonographic film showing dilated air and fluid filled
coils of gut
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(ii)
(iii)
(i)
Fig. No. 4
(i) Plain X-ray abdomen showing radio-opaque shadow in
left renal area
(ii) IVP film showing duplex left pelvicalyceal system with
uretrocele (cobrahead appearance) with ureterolithiasis.
(iii) U/S film showing dilated left terminal and intramural
portion of ureter projecting into urinary bladder, showing two
calculi with distal acoustic shadow
(iv) Left kidney showing severe hydronephrotic changes with
calculi with distal acoustic shadowing, soft and thick internal
echoes seen
(iv)
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114 K Gupta et al
TABLE I
SHOWING COMPARATIVE STUDY OF CLINICAL, RADIOGRAPHIC AND ULTRASONOGRAPHIC CO-RELATION
Disease
Acute cholecystitis
Acute appendicitis
Acute pancreatitis
Renal
Acute peptic ulcer
Amoebic liver abscess
Intestinal obstruction
Gynaecological pathologies
Infantile hypertrophic pyloric stenosis
Psoas abscess
Perforation
Clinical diagnosis
Radiographic diagnosis
U/S diagnosis
16
13
6
6
3
2
2
1
1
0
1
1
1
0
5
0
0
2
0
0
1
2
13
TABLE II
COMPARATIVE ACCURACIES OF CLINICAL DIAGNOSIS, X-RAY AND ULTRASOUND EXAMINATION
Sr. Diagnosis
No.
Predictive
Sensitivity Predictive Sensitivity Predictive Sensitivity
accuracy of
of clinical accuracy of of x-ray film accuracy of ultrasound
clinical diagnosis diagnosis % x-ray film %
%
of ultrasound
%
1. Acute cholecystitis
81.2
100.0
0.76
100.0
100.0
100.0
2. Acute pancreatitis
100.0
66.67
0
0
100.0
100.0
3. Amoebic liver abscess
100.0
66.7
0
0
100.0
100.0
4. Acute appendicitis
61.4
100.0
1.2
100.0
83.3
100.0
5. Gynaecological pathologies
16.6
100.0
0
0
100.0
100.0
6. Renal pathologies
83.3
100.0
100.0
100.0
100.0
100.0
7. Peptic ulcer (perforation)
66.6
100.0
100.0
100.0
100.0
50.0
8. GIT obstruction
100.0
100.0
100.0
100.0
100.0
50.0
9. Hypertrophic pyloric stenosis 100.0
100.0
0
0
100.0
50.0
10. Psoas abscess
0
0
100.0
100.0
100.0
100.0
11. Overall accuracy
70.9
83.3
4.1
60.0
98.3
90.0
cyst (Fig. V), 2 cases of tuboovarian masses, 1 case of
pelvic collection. One case of ruptured ectopic pregnancy
was diagnosed on ultrasound in our study which was
confirmed at surgery. Foetal heart activity could not be
demonstrated. Greater than 90% accuracy in diagnosing
ectopic pregnancy based upon classic sonographic signs
ectopic gestational sac, enlarged non gravid uterus and
free fluid in the cul de sac. Foetal heart activity is not
routinely demonstrated at early gestational age. Foetal
heart activity was possible in less than half of the
cases(21).
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IJRI, 15:1, February 2005
250, 1977.
771, 1985.
1335-1344, 1993.
103, 1997.
1001, 1978.
12. Jeffary RB, Laing FC, Lewis FR. Acute appendicitis. High
1987.
1992.
19. David and Simon J. The bladder and prostrate. Text book
1983.
1984.
172-174, 1991.
226, 1981.
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Indian Radiologist