Article

O uso da ultra-sonografia no diagnóstico e evolução da apendicite aguda

Radiologia Brasileira 01/2003; DOI: 10.1590/S0100-39842003000200004
Source: DOAJ

ABSTRACT OBJETIVO: Aproximadamente 35% das apendicites agudas têm diagnóstico clínico pré-operatório duvidoso ou incorreto, particularmente grávidas e crianças. A ultra-sonografia, em virtude do seu baixo custo e facilidade de acesso, tem-se mostrado um método diagnóstico importante. Este estudo propôs-se a demonstrar os principais achados de imagem das diversas fases da apendicite, com o objetivo de auxiliar o ultra-sonografista no diagnóstico precoce desta afecção. MATERIAIS E MÉTODOS: São relatados 14 casos de ultra-sonografias abdominais realizadas no período de janeiro a julho de 2001, em pacientes que se apresentavam com quadro de abdome agudo. O exame foi realizado com transdutores de 3,5 MHz e 7,5 MHz. RESULTADOS: O estudo ultra-sonográfico antes da perfuração demonstra apêndice não compressível, com espessamento e perda focal da definição das paredes. Após a perfuração, o apêndice pode não ser visualizado ao exame de ultra-sonografia, sendo evidenciadas alterações secundárias como efeito de massa, formação de plastrão, liquefação e formação de abscesso, além de ar dentro da coleção. CONCLUSÃO: O diagnóstico precoce da apendicite é essencial para minimizar a morbidade, que se mantém elevada se ocorrer perfuração. Apresentações atípicas resultam em confusão diagnóstica e retarde no tratamento. As principais dificuldades e erros são apendicite retrocecal, apendicite focal ou perfurada.

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    ABSTRACT: Objective: To evaluate the role of sonography in diagnosis of acute appendicitis, with an emphasis on early evolution cases. Methods: From 240 cases with the diagnosis of appendicitis, a retrospective study of 149 patients submitted to appendicectomy at the Hospital Israelita Albert Einstein, in 2002, was carried out. The appendix of these 149 patients was visualized in a preoperative sonography and the diagnosis was confirmed by histological examination. Patients were distributed into two groups - initial and advanced - according to the measure of the largest external diameter of the appendix. The statistical data analysis included demographic information (sex and age) and direct and indirect signs of acute appendicitis. Results: There were more cases of acute appendicitis in the groups aged 10-30 years, mean age of 18.3 years in the initial group and 26.4 years in the advanced group. There was no statistically significant difference regarding sex. The advanced group presented 4.5% of false-positive results and the initial group, 23.1%. Among the direct signs, non-compressibility of the appendix stood out and was observed in more than half cases; with regard to indirect signs, hyperechogenicity of periappendiceal tissues was observed in up to 75% of cases in both groups. Conclusion: There was a statistically significant difference in false-positive cases, which were more often observed in the initial group. Therefore, sonographic follow-up is recommended in these cases.

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