A recent systematic review and meta-analysis evaluated the diagnostic accuracy of ultrasound in detecting acute diverticulitis. The analysis included 12 studies with a total of 2,056 patients. Ultrasound demonstrated a sensitivity of 92.5% (95% CI: 86.9%–95.8%) and a specificity of 87.7% (95% CI: 75.7%–94.2%).
The most commonly used diagnostic criteria across the studies included:
Presence of diverticula with tenderness on graded compression
Bowel wall thickness > 4 mm
Pericolic fat inflammation
Similar to prior research on POCUS for nephrolithiasis, these findings support a POCUS-first approach for patients at low risk for serious alternative diagnoses. Ultrasound is a great alternative for patients with contraindications to contrast-enhanced CT, such as those with contrast allergies.
As the authors state, while ultrasound may be effective in identifying acute diverticulitis and its complications, such as abscess, additional imaging with CT may still be required to assess the severity of complications.
References
Shokoohi H, Peksa GD, Hutchison A, Al Jalbout N, Montoya K, Westrick JC, Goldsmith A, Nazerian P, Gottlieb M. Ultrasound accuracy in acute diverticulitis: A systematic review and Meta-analysis. Am J Emerg Med. 2025 Mar 10;92:96-103. doi: 10.1016/j.ajem.2025.03.002.
