Investigating the Impact of the Amount of Contrast Material used in Abdominal CT Examinations Regarding the Diagnosis of Appendicolith
Author(s): Eleftherios Lavdas, Nadia Boci, Lia Sarantaenna, Maria Papaioannou, Ioannis Ntavelis, Theodoros Theodoropoulos, Lida Gogou, Panayiotis Mavroidis
Purpose: Acute appendicitis is a clinical emergency and is one of the more common causes of acute abdominal pain. Consequently, to avoid significant unpleasant consequences it is necessary have early diagnosis and treatment. Commonly, in patients with signs of appendicitis an abdominal computed tomography (CT) examination should be performed.
Materials/methods: Out of 12 cases of patients with acute appendicitis. The presence of an appendicolith was one common finding in the CTs of those cases. Almost one third of patients show the presence of appendicoliths, which may have prognostic importance since their presence has been associated with increased likelihood for appendiceal perforation.
Results: In the first case, a young adult underwent a CT examination with incomplete oral administration of contrast material. This revealed the existence of an appendicolith, which caused acute appendicitis. The second patient with acute appendicitis is an adult who was diagnosed 40 days after his CT pyelography, in which small appedicoliths were not observed.
Conclusion: In cases where there is suspicion for acute appendicitis, nephrolithiasis and ureterolithiasis, it is proposed to CT scan the patient without oral contrast material. This targeted pelvis CT scan should be of low dose covering the region of cecum. Subsequently, oral and IV contrast should be administered and an enhanced CT should be acquired to succeed gastric intestinal differentiation. In this way, we can avoid covering the lower abdomen and identify better any small stones.