Plain abdominal X-rays are highly useful for diagnosing small bowel obstruction, large bowel obstruction, and pneumoperitoneum, often serving as the initial imaging modality. However, acute appendicitis is an inflammatory condition of a small, retrocecal or pelvic organ. While an AXR might occasionally show non-specific findings like a fecalith, localized ileus, or scoliosis, it has very low sensitivity and specificity for diagnosing or ruling out acute appendicitis. Cross-sectional imaging like ultrasound (especially in children and pregnant women) or CT scan (in adults) is the preferred modality for diagnosing acute appendicitis.
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