Acute appendicitis in children: value of sonography in detecting perforation.

Quillin, S P; Siegel, Marilyn J.; Coffin, Cheryl M.

doi:10.2214/ajr.159.6.1442398

Cited by 89 publications

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“…Although many studies have explored sonographic findings associated with acute appendicitis, few investigations discuss specific signs that can reliably differentiate perforated appendicitis from acute appendicitis prior to abscess formation. The findings of a loculated fluid collection and absence of the echogenic appendiceal submucosal layer have been shown to be predictive of perforated appendicitis in children [14] and adults [15,16]. The secondary sonographic findings of echogenic mesenteric fat, fluid collections and dilated bowel were found to be helpful in the diagnosis of acute appendicitis in children when the appendix was not visualized [17].…”

Section: Introductionmentioning

confidence: 99%

The challenging ultrasound diagnosis of perforated appendicitis in children: constellations of sonographic findings improve specificity

et al. 2014

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Section: Introductionmentioning

confidence: 99%

The challenging ultrasound diagnosis of perforated appendicitis in children: constellations of sonographic findings improve specificity

et al. 2014

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“…Additional causes of false negative reports can be due to focal (tip) appendicitis or a perforated appendix, which can occur in 20-30% of the cases [11]. A perforated appendix can make a more difficult diagnosis due to decompression of the appendix lumen.…”

Section: Journal Of Pediatric Carei Issn 2471-805xmentioning

confidence: 99%

Appendicitis Ultrasound: Comparison Study of the Radiology Resident to the Technologist and Attending

Allaei¹

2016

J Pediatr Care

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Background and objects: Community hospitals and academic centers may not always have a radiologist or sonographer on site, and the responsibility of US performance after hours maybe left to a resident. The purpose of this study was to evaluate a growing concern at our institution that a higher numbers of pediatric CT scans were being conducted overnight for the evaluation of acute appendicitis, as a result of a perception that scans performed by residents were not as accurate as those performed by technologists and/or attending. Materials and methods:573 patients initially evaluated by ultrasound for appendicitis, from April 2008 to March 2014. Studies were distinguished by either resident or technologist and attending (TA) performing the procedure. The junior resident was in the first to third years of training with at least 8 weeks of US experience. Follow-up computed tomography and operative reports were reviewed to determine if appendicitis was later confirmed. Results:Of 462 studies in the pediatric non-pregnant group, ages one to eighteen years, 261 (56.5%) were performed by a junior resident and 201 (43.5%) were performed by the TA group. The sensitivity of diagnosing acute appendicitis in the first ultrasound by the resident and TA groups were 59% and 67%, respectively (p=0.73). Additional testing ordered after a negative initial US was higher in the resident group than the TA group, 85 (39.5%) and 46 (26.4%), respectively (p=0.010). The number of false negatives in the overall, resident and TA groups were 35 (38%), 24 (41%) and 11 (33%), respectively (p=0.68). Conclusion:Although appendicitis US has been traditionally touted as operator dependent, there was no statistical difference in this study between residents and attendings of varying levels of experience. Additionally, more follow up studies were ordered when the initial study was negative and performed by the resident.

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“…As appendiceal inflammation becomes more severe, the mucosa of the appendix, which is normally echogenic on ultrasonography, becomes disrupted and eventually may be completely lost [29] (Fig. 7).…”

Section: Perforated Appendicitismentioning

confidence: 99%

The use of advanced imaging for appendicitis in children

John

2000

Emergency Radiology

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Improved resolution of late-generation CT and US technology has fostered an increased reliance on imaging for the preoperative diagnosis or exclusion of appendicitis. Both modalities have been shown to have a high accuracy rate, but certain diagnostic challenges persist. CT has largely replaced US for the diagnosis of appendicitis in adults, but the modality of choice is less clear in children. US is usually more easily and rapidly performed in young patients, obviating the need for contrast administration and sedation. Ionizing radiation exposure is avoided with US. Assessment of physical signs and symptoms can be achieved while performing US, an advantage over CT. However, US is best interpreted during performance of the examination, and thus CT is often favored when the interpreter is in a remote location. Strategies using limited CT to follow an indeterminate US show high diagnostic accuracy. This article discusses the controversy surrounding the optimal imaging approach to acute abdominal pain in children and illustrates some of the challenges encountered with US and CT for the evaluation of appendicitis.

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Acute appendicitis in children: value of sonography in detecting perforation.

Cited by 89 publications

References 0 publications

The challenging ultrasound diagnosis of perforated appendicitis in children: constellations of sonographic findings improve specificity

The challenging ultrasound diagnosis of perforated appendicitis in children: constellations of sonographic findings improve specificity

Appendicitis Ultrasound: Comparison Study of the Radiology Resident to the Technologist and Attending

The use of advanced imaging for appendicitis in children

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