ARRS 2022 Abstracts

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1481. Findings on Emergent Magnetic Resonance Imaging in Pregnant Patients With Suspected Appendicitis: A Single Center Perspective
Authors * Denotes Presenting Author
  1. Hila Bufman; Sheba Medical Center
  2. Daniel Raskin; Sheba Medical Center
  3. Yiftach Barash; Sheba Medical Center
  4. Yael Inbar; Sheba Medical Center
  5. Roy Mashiach; Sheba Medical Center
  6. Noam Tau *; Sheba Medical Center
Objective:
Right lower quadrant (RLQ) pain during pregnancy is a common complaint that poses a diagnostic challenge given the limitation in use of ionizing radiation and changes in anatomy resulting from the enlarged uterus, which limits the diagnostic yield of ultrasound. Given these limitations, there is an increase in use of MRI in the acute setting of RLQ pain in pregnant patients. Here, we describe the most common findings on emergent MRI performed to rule out appendicitis during pregnancy.

Materials and Methods:
In this institutional review board-approved study, we retrospective assessed all consecutive pregnant patients who presented to the emergency room with RLQ pain, were deemed by their treating surgeon as having suspected appendicitis and underwent non-contrast-enhanced MRI. We performed a review of all abdominal MRI and collected data from the electronic patient files to assess for any possible pathology to explain the patients' presentation, both on clinical assessment and on MRI.

Results:
Overall, 93 women were included in this study, and median age was 30 years. The median gravidity number was 2; median parity was 1. The median gestational age was 19 weeks. Eighty-eight (94.6%) patients underwent a diagnostic ultrasound prior to MRI, with 62/88 (70.4%) reported as negative for pathological findings; 3/88 (3.4%) were positive for acute appendicitis; 12/88 (13.6%) were inconclusive; and 11/88 (12.5%) offered an alternative diagnosis (including right sided hydronephrosis and hydrosalpynx). Out of 93 women who underwent MRI, 18 (19.3%) were positive for acute appendicitis and 27 (29%) patients had an alternative pathology: gynecological (14), urological (4) and surgical (3). After MRI, 55/93 (59.1%) patients received no treatment; 18 (19.3%) patients received antibiotic treatment (either for pyelonephritis or empirically); 20/93 (21.5%) patients underwent surgery, and 19/20 (95%) were appendectomies. Of the 19 appendectomies, 18 were MRI and pathology proven; one further case had no appendiceal pathology on MRI, and the appendix was confirmed as normal on post-operative pathological assessment. One patient underwent surgery for an ectopic pregnancy.

Conclusion:
In our cohort, emergent MRI for acute RLQ pain in pregnant patients found an explanation for the patients' complaints in nearly half the patients. Alternative diagnoses proposed on MRI included gynecological and urological causes for pain.