Clinical Differentiation between Acute Appendicitis and Acute Mesenteric Lymphadenitis in Children

Toorenvliet, Boudewijn R.; Vellekoop, Annelies; Bakker, Rutger F. R.; Wiersma, Fraukje; Mertens, Bart; Merkus, J. W. S.; Breslau, Paul J.; Hamming, J. F.

doi:10.1055/s-0030-1267979

Cited by 39 publications

(49 citation statements)

References 21 publications

(34 reference statements)

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“…Therefore, the shortaxis diameter of LMLN can be applied for the evaluation of each age group, rather than the long-axis diameter or average diameter. This result is consistent with the concept of using the short-axis diameter as the diagnostic parameter in existing criteria [2,7,9,11,12].…”

Section: Size Gender 2-3 Yr 3-4 Yr 4-5 Yr 5-6 Yr 6-7 Yrsupporting

confidence: 91%

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Reference intervals of mesenteric lymph node size according to lymphocyte counts in asymptomatic children

Cai

Zhang

2020

PLoS ONE

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There is no acknowledged reference interval of mesenteric lymph node size in healthy children, and the size criterion for mesenteric lymph node enlargement (MLNE) has long been controversial. This study aimed to explore the reference intervals of mesenteric lymph node size according to lymphocyte counts in asymptomatic children and to develop a more appropriate definition of MLNE. The asymptomatic children included were divided into five age strata: 2 to 3 yr; 3 to 4 yr; 4 to 5 yr; 5 to 6 yr; and 6 to 7 yr. Correlation analyses between lymphocyte counts and the long-axis diameter, short-axis diameter, and average diameter of the largest mesenteric lymph node (LMLN) were performed. A reference interval of the short-axis diameter of LMLN was established according to this correlation analysis in each age group. We also report a reference interval of lymphocyte count in each age group. This study revealed significant correlations between the short-axis diameter of LMLN and lymphocyte count in all age groups, as well as in subdivided boy groups and girl groups. The overall reference interval of the short-axis diameter of LMLN in children was 0.54 cm-1.03 cm, with mean value of 0.75 cm. This study supports the use of the short-axis diameter greater than 8-10 mm as the diagnostic criterion for primary mesenteric lymphadenitis based on the presence of a cluster of three or more mesenteric lymph nodes and in the absence of other abnormalities.

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Section: Size Gender 2-3 Yr 3-4 Yr 4-5 Yr 5-6 Yr 6-7 Yrsupporting

confidence: 91%

“…The current definition of MLNE is a cluster of three or more lymph nodes with short-axis diameter � 5 mm [2,9]. However, a MLN greater than 5 mm in the short-axis diameter is a common ultrasound finding in children during clinic examination and is frequently observed in asymptomatic children [7].…”

Section: Introductionmentioning

confidence: 99%

Reference intervals of mesenteric lymph node size according to lymphocyte counts in asymptomatic children

Cai

Zhang

2020

PLoS ONE

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“…The current literature on the test characteristics of US for diagnosis of appendicitis is composed of mainly single‐center studies, where US has been found to have varied sensitivity (78% to 100%) and specificity (88% to 98%) . US is well known to be operator‐dependent, yet there is scant information about its performance at centers using it infrequently .…”

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confidence: 99%

Performance of Ultrasound in the Diagnosis of Appendicitis in Children in a Multicenter Cohort

et al. 2013

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Objectives The objectives were to assess the test characteristics of ultrasound (US) in diagnosing appendicitis in children and to evaluate site-related variations based on the frequency of its use. Additionally, the authors assessed the test characteristics of US when the appendix was clearly visualized. Methods This was a secondary analysis of a prospective, 10-center observational study. Children aged 3 to 18 years with acute abdominal pain concerning for appendicitis were enrolled. US was performed at the discretion of the treating physician. Results Of 2,625 patients enrolled, 965 (36.8%) underwent abdominal US. US had an overall sensitivity of 72.5% (95% confidence interval [CI] = 58.8% to 86.3%) and specificity 97.0% (95% CI = 96.2% to 97.9%) in diagnosing appendicitis. US sensitivity was 77.7% at the three sites (combined) that used it in 90% of cases, 51.6% at a site that used it in 50% of cases, and 35% at the four remaining sites (combined) that used it in 9% of cases. US retained a high specificity of 96% to 99% at all sites. Of the 469 (48.6%) cases across sites where the appendix was clearly visualized on US, its sensitivity was 97.9% (95% CI = 95.2% to 99.9%), with a specificity of 91.7% (95% CI = 86.7% to 96.7%). Conclusions Ultrasound sensitivity and the rate of visualization of the appendix on US varied across sites and appeared to improve with more frequent use. US had universally high sensitivity and specificity when the appendix was clearly identified. Other diagnostic modalities should be considered when the appendix is not definitively visualized by US.

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“…It is now more acceptable to perform appendectomy on normal appendix with the availability of well-trained surgeons and nurses in hospitals appendectomies for normal appendix [25] . It is known by the mnemonic 'MANTRELS' and is scored as follows: right iliac fossa pain (1 point), anorexia (1 point), nausea or vomiting (1 point), right lower quadrant tenderness (2 point), rebound tenderness(1 point), elevated temperature ≥ 37.3°C (1 point), leukocytes ≥ 11 000 (2 points), and differential white blood cell count with 75% neutrophils (1 point) [26,27] . Alvarado scores have been previously shown to be relatively sensitive and specific in adults with lower right quadrant pain.…”

Section: Discussionmentioning

confidence: 99%

Combination of Alvarado score and ultrasound findings in diagnosis of acute appendicitis in children

Fakhry

Shawky

2017

J Pediatr Dis

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Appendicitis is the most common cause of emergency abdominal surgeries in children. Ultrasound (US) has been proven to be a helpful imaging modality in patient evaluation, especially in children suspected of appendicitis. The Alvarado score is a 10-point scoring system for the diagnosis of appendicitis based on clinical data and differential leukocyte count. The aim of the present study was to evaluate a combination of clinical scoring (Alvarado score) and US findings for accurate diagnosis of appendicitis in children. The study was done in Menoufia University Hospitals from March 2011 to January 2013. 322 children with abdominal pain clinically suspected of having appendicitis were included in the study and clinically assessed to calculate the Alvarado score. Patients were referred to the radiology department for abdominal US. Among the 153 of the 322 patients who were operated on, 149 patients were diagnosed pre-operatively with acute appendicitis and 4 girls were diagnosed with complex ovarian cysts. Of the 149 patients diagnosed with appendicitis, the percentage of appendicitis was 93% (139/149) and 10 (7%) patients had normal appendix. The prevalence of appendicitis among the patients of the study was 43% (139/322). In conclusion, a combination of Alvarado scores and abdominal US is a good approach for the diagnosis of appendicitis in children to reduce the number of laparotomies for normal appendix. In the case of normal appendix or nonvisualization of the appendix via abdominal US without a high Alvarado score, appendicitis can be safely ruled out. If it is proven as an inflamed appendix on US or a high Alvarado score, patient should be subjected for appendectomy without delay. Keywords

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Clinical Differentiation between Acute Appendicitis and Acute Mesenteric Lymphadenitis in Children

Abstract: It is not possible to accurately distinguish acute mesenteric lymphadenitis from acute appendicitis in children using clinical evaluation alone. Ultrasound should be performed in equivocal cases.

Cited by 39 publications

References 21 publications

Reference intervals of mesenteric lymph node size according to lymphocyte counts in asymptomatic children

Reference intervals of mesenteric lymph node size according to lymphocyte counts in asymptomatic children

Performance of Ultrasound in the Diagnosis of Appendicitis in Children in a Multicenter Cohort

Combination of Alvarado score and ultrasound findings in diagnosis of acute appendicitis in children

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