Friday, October 28, 2011

Defining and diagnosing appendicitis

Reginald Heber Fitz, MD

MGH pathologist Reginald Heber Fitz, MD, first described appendicitis – a term he coined – and suggested a “radical operation” to remove the inflamed structure in an 1886 presentation to the first meeting of the Association of American Physicians. While descriptions of what was probably appendicitis went back hundreds of years and abscesses or perforation of the structure had been noted in autopsies, there was considerable dispute about whether or not the appendix was significantly involved in painful inflammation of the right lower abdomen. Fitz’s comprehensive description would become known as a landmark in the understanding of this life-threatening condition.

Appendicitis remains one of the most common causes of abdominal surgery today, and MGH physicians have continued to advance its diagnosis and treatment. In 1996, MGH radiologists reported that helical computed tomography (CT) imaging diagnosed appendicitis more quickly and accurately than other methods – while ruling out patients whose symptoms were caused by another condition.


PAINFUL PICTURE: A CT image showing an "
inflamed appendix, rendered here in green

Robert Novelline, MD, director of Emergency Radiology, says the MGH-developed technique is now widely used and is estimated to prevent up to 50,000 unnecessary operations per year. “It has been extremely rewarding that the CT technique for the diagnosis of acute appendicitis has become adopted at medical centers throughout the U.S. and many parts of the world.”

Novelline says the overall accuracy of the appendiceal CT is approaching 99 percent. “The most recent advancement in appendiceal imaging is the use of new imaging technologies that permit performance of appendiceal CT with less than 50 percent of the radiation exposure compared to a decade ago,” he adds. We also have developed an MRI protocol for diagnosing suspected appendicitis in pregnant patients in whom we wish to avoid radiation exposure.” 

Read more articles from the 10/28/11 Hotline issue.


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