Faculty Bibliography

PURPOSE: To compare the accuracy of computed tomography (CT) and ultrasonography (US) in the diagnosis of acute appendicitis. MATERIALS AND METHODS: One hundred consecutive patients were examined with US and CT, and the results, independently reported, were correlated with surgical and histopathologic findings (69 patients) and data from other laboratory and clinical follow-up (31 patients). RESULTS: Fifty-four patients had acute appendicitis; 46 patients did not. Analysis of the data for CT and US, respectively, revealed sensitivity, 96% versus 76%; specificity, 89% versus 91%; accuracy, 94% versus 83%; positive predictive value, 96% versus 95%; and negative predictive value, 95% versus 76%. In the 46 patients without appendicitis, an alternative diagnosis was made with CT in 22 patients and with US in 15. CT scans showed abscesses and/or phlegmons in 28% of patients with appendicitis versus 17% at US. Results of CT and US were discordant in 20 patients; CT findings were correct in 17 and US findings in three. CONCLUSION: CT is more accurate than US in diagnosis of acute appendicitis

Sonographic examination of the abdomen was performed in 155 patients with clinical diagnosis of AIDS. Approximately one half of the patients had hyperechoic (fatty) liver and splenomegaly. About one third of the patients had lymphadenopathy and hyperechoic kidneys. Intravenous drug abusers were more likely to have renal parenchymal changes, whereas patients with sexually transmitted AIDS have a greater incidence of splenomegaly. Lymphadenopathy is the most consistent finding that would question the immune competency of a patient in the appropriate clinical setting. The usefulness of sonography lies in the detection or exclusion of potentially treatable complications in AIDS

To differentiate pregnancies complicated by oligohydramnios due to intrauterine growth retardation from those due to renal agenesis, the authors administered furosemide intravenously to eight pregnant women (19-25 weeks gestation) with oligohydramnios. The fetal abdomen was scanned with ultrasound to demonstrate the fetal urinary bladder. In six fetuses, sonography failed to demonstrate the bladder: two fetuses had growth retardation with normal kidneys and bladder, and four had renal anomalies. It is concluded that administration of furosemide to the mother fails to induce diuresis in growth-retarded fetuses of 19-23 weeks gestation and that failure to see the fetal bladder after furosemide administration does not necessarily indicate absent fetal kidneys