Log in

“Rule out appendicitis”: a Canadian emergency radiology perspective on medicolegal risks, imaging pitfalls, and strategies to improve care

  • Review Article
  • Published:
Emergency Radiology Aims and scope Submit manuscript

Abstract

We provide a unique Canadian perspective on the medicolegal risks associated with imaging acute appendicitis, incorporating data requested from the Canadian Medical Protective Association (CMPA) on closed medicolegal cases over the past decade. We include a review of current clinical and imaging guidelines in the diagnosis and management of this common emergency room presentation. A case-based approach is implemented in this article to explore ways to mitigate potential errors in the diagnosis of acute appendicitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (United Kingdom)

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. Touchie C (2013) Report of the Incidence and Prevalence of Diseases and Other Health Related Issues in Canada. Medical Council of Canada Blueprint Project. https://mcc.ca/wp-content/uploads/Touchie-Incidence-Prevalence-Report.pdf. Accessed July 2, 2023

  2. Sosner E, Patlas MN, Chernyak V, Dachman AH, Katz DS (2017) Missed acute appendicitis on multidetector computed tomography and magnetic resonance imaging: legal ramifications, challenges, and avoidance strategies. Curr Probl Diagn Radiol 46(5):360–364

    Article  PubMed  Google Scholar 

  3. CMPA (2020) CMPA report: challenges in diagnosing acute appendicitis associated with diagnostic imaging, p 1–6. See supplemental material

  4. CMPA (2021) Medical-legal handbook for physicians in Canada. https://www.cmpa-acpm.ca/en/advice-publications/handbooks/medical-legal-handbook-for-physicians-in-canada. Accessed June 10, 2023

  5. Ward M, Visser R, Gillman L (2018) Acute Appendicitis: Dynamic Practice Guidelines for Emergency General Surgery. Committee on Acute Care Surgery, Canadian Association of General Surgeons. https://cags-accg.ca/wp-content/uploads/2019/07/ACS-Handbook-CPG-Ch-7-Appendicitis-.pdf. Accessed July 2, 2023

  6. American College of Radiology (2022) American College of Radiology ACR Appropriateness Criteria® Right Lower Quadrant Pain. https://acsearch.acr.org/docs/69357/Narrative/. Accessed July 2, 2023

  7. Meckler G, Sabhaney V, Skaarsgard E, Brae H (2017) ED Pathway for Evaluation/Treatment of Patient with Suspected Non-Perforated Appendicitis. https://www.bcemergencynetwork.ca/clinical_resource/suspected-appendicitis-in-children/. Accessed June 17, 2023

  8. Nah SA, Ong SS, Lim WX, Amuddhu SK, Tang PH, Low Y (2017) Clinical relevance of the nonvisualized appendix on ultrasonography of the abdomen in children. J Pediatr 182:164–9.e1

    Article  PubMed  Google Scholar 

  9. Puylaert J, Nolthenius J (2020) The Radiology Assistant: Appendicitis - Pitfalls in US and CT diagnosis. https://radiologyassistant.nl/abdomen/acute-abdomen/appendicitis-pitfalls-in-us-and-ct-diagnosis. Accessed June 12, 2023

  10. Sauvain MO, Tschirky S, Patak MA, Clavien PA, Hahnloser D, Muller MK (2016) Acute appendicitis in overweight patients: the role of preoperative imaging. Patient Saf Surg 10:13

    Article  PubMed  PubMed Central  Google Scholar 

  11. Fursevich DM, LiMarzi GM, O’Dell MC, Hernandez MA, Sensakovic WF (2016) Bariatric CT imaging: challenges and solutions. Radiographics 36(4):1076–1086

    Article  PubMed  Google Scholar 

  12. Carucci LR (2013) Imaging obese patients: problems and solutions. Abdom Imaging. 38(4):630–46

    Article  PubMed  Google Scholar 

  13. Burns M, Hague CJ, Vos P, Tiwari P, Wiseman SM (2017) Utility of magnetic resonance imaging for the diagnosis of appendicitis during pregnancy: a canadian experience. Can Assoc Radiol J 68(4):392–400

    Article  PubMed  Google Scholar 

  14. Shin I, Chung YE, An C, Lee HS, Kim H, Lim JS et al (2018) Optimisation of the MR protocol in pregnant women with suspected acute appendicitis. Eur Radiol 28(2):514–521

    Article  PubMed  Google Scholar 

  15. Lin W, Jeffrey RB, Trinh A, Olcott EW (2017) Anatomic reasons for failure to visualize the appendix with graded compression sonography: insights from contemporaneous CT. AJR Am J Roentgenol 209(3):W128–W138

    Article  PubMed  Google Scholar 

  16. Burkhardt JH, Arshanskiy Y, Munson JL, Scholz FJ (2011) Diagnosis of inguinal region hernias with axial CT: the lateral crescent sign and other key findings. Radiographics 31(2):E1-12

    Article  PubMed  Google Scholar 

  17. Willekens I, Peeters E, De Maeseneer M, de Mey J (2014) The normal appendix on CT: does size matter? PLoS ONE 9(5):e96476

    Article  PubMed  PubMed Central  Google Scholar 

  18. Murray N, Darras KE, Walstra FE, Mohammed MF, McLaughlin PD, Nicolaou S (2019) Dual-energy CT in evaluation of the acute abdomen. Radiographics 39(1):264–286

    Article  PubMed  Google Scholar 

  19. Egri C, Darras KE, Scali EP, Harris AC (2018) Classification of error in abdominal imaging: pearls and pitfalls for radiologists. Can Assoc Radiol J 69(4):409–416

    Article  PubMed  Google Scholar 

  20. Quadri R, Vasan V, Hester C, Porembka M, Fielding J (2019) Comprehensive review of typical and atypical pathology of the appendix on CT: cases with clinical implications. Clin Imaging 53:65–77

    Article  PubMed  Google Scholar 

  21. Srinivasa Babu A, Brooks ML (2015) The malpractice liability of radiology reports: minimizing the risk. Radiographics 35(2):547–554

    Article  PubMed  Google Scholar 

  22. Canadian Association of Radiologists (2010) CAR Standard for Communication of Diagnostic Imaging Findings. https://car.ca/wp-content/uploads/Communication-of-Diagnostic-Imaging-Findings.pdf. Accessed July 7, 2023

  23. Zinsser D, Maurer M, Do PL, Weiß J, Notohamiprodjo M, Bamberg F et al (2019) Reduced scan range abdominopelvic CT in patients with suspected acute appendicitis - impact on diagnostic accuracy and effective radiation dose. BMC Med Imaging 19(1):4

    Article  PubMed  PubMed Central  Google Scholar 

  24. Paulson EK, Coursey CA (2009) CT protocols for acute appendicitis: time for change. AJR Am J Roentgenol. 193(5):1268–71

    Article  PubMed  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lee Treanor.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 1376 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Treanor, L., Drury, A., Egri, C. et al. “Rule out appendicitis”: a Canadian emergency radiology perspective on medicolegal risks, imaging pitfalls, and strategies to improve care. Emerg Radiol 31, 239–249 (2024). https://doi.org/10.1007/s10140-024-02214-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10140-024-02214-4

Keywords

Navigation