The Role of Ultrasonography in the Evaluation of Peri-Anal Lesions

Background: Perianal lesions represent a wide spectrum of conditions including abscesses, fistulas, hematomas, and thrombosed piles.Their overlapping clinical features often make diagnosis challenging,necessitating imaging support. Ultrasonography (USG) has emerged as a reliable, cost-effective, and non-invasive modality for evaluating perianal pathology.The present study aimed to assess the diagnostic role of ultrasonography in perianal lesions and to determine its accuracy in comparison with surgical, histopathological, and clinical outcomes. Methods: This hospital-based prospective, observational, cross-sectional study was conducted in the Department of Radiodiagnosis, Sri Aurobindo Medical College and Post Graduate Institute, Indore, from June 2023 to November 2024. Fifty patients with clinically suspected perianal lesions underwent USG using GE LOGIQ E9 and F8 machines with 4 MHz curvilinear and 7.5–15 MHz linear probes. Imaging findings were correlated with operative, histopathological, or follow-up results. Data were analyzed with SPSS v26.0;Chi-square test was used and p < 0.05 was considered significant.Results:The study included 34 males (68%) and 16 females (32%),with a mean age of 38.4 years.Perianal pain (90%) was the commonest symptom. USG revealed perianal abscesses in 22 cases (44%), fistulas in 16 (32%), hematomas in 5 (10%), thrombosed piles in 3 (6%), and indeterminate lesions in 4 (8%). Ischiorectal abscess was the most frequent subtype (45.5%), while intersphincteric fistula was the predominant fistula type (37.5%).Ultrasonographic diagnosis correlated with operative or clinical findings in 47 of 50 evaluable cases, yielding a diagnostic accuracy of 94%, sensitivity 93.75%, specificity 100%, PPV 100%, and NPV 40% (p <0.0001).Conclusion:Ultrasonography is a highly accurate, non-invasive modality for evaluating perianal lesions. It correlates well with surgical findings and should be considered a frontline imaging tool,particularly in resource-limited settings.