Imaging Evaluation of Suspected Appendicitis in a Pediatric  Population

Sivit, Carlos J.; Applegate, Kimberly E.; Stallion, Anthony; Dudgeon, David; Salvator, Ann; Schluchter, Mark D.; Berlin, Sheila C.; Myers, Melissa T.; Borisa, Valerie J.; Weinert, Dayna M.; Morrison, Stuart C.; Grisoni, Enrique R.

doi:10.2214/ajr.175.4.1750977

Cited by 136 publications

(57 citation statements)

References 21 publications

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“…Likewise, the range of overall accuracy has been reported to be 59%-98%, but narrows to 89%-98% when only pediatric studies are examined (Table 3). 9,[23][24][25][26][27][28] A 2004 study reported a sensitivity of 100%, a specificity of 93% and an overall accuracy of 98% using contrast-enhanced Doppler ultrasound. 45 Another study evaluated operator-dependant techniques in 877 patients (age range 2-85 yr) with abdominal ultrasound to which they applied 4 additional manoeuvres to the standard examination.…”

Section: Ultrasoundmentioning

confidence: 99%

Pediatric appendicitis: pathophysiology and appropriate use of diagnostic imaging

Brennan

2006

CJEM

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Evaluating children for appendicitis can be extremely difficult, and various strategies have been developed to improve the precision of preoperative diagnosis. Among these, ultrasound and computed tomography (CT) are now widely used but remain controversial. Although CT scanning is superior to ultrasound in terms of diagnostic accuracy for appendicitis, the large dose of ionizing radiation from CT and the risk of subsequent radiation-induced malignancy (RIM) are of particular concern in pediatric patients. This article reviews the literature on the pathophysiology, morbidity and mortality of appendicitis, summarizes the data regarding pediatric imaging in appendicitis, provides a practical approach to imaging for clinicians who evaluate pediatric patients, and makes recommendations for reducing the risk of RIM in pediatric patients. RÉSUMÉIl peut être extrêmement difficile d'évaluer les enfants pour diagnostiquer l'appendicite et diverses stratégies ont été mise au point pour améliorer la précision du diagnostic préopératoire. L'échographie et la tomodensitométrie (TDM), notamment, sont maintenant très répandues, mais elles demeurent controversées. Même si la TDM est supérieure à l'échographie pour ce qui est de l'exactitude du diagnostic d'appendicite, une dose importante de rayonnements ionisants provenant de l'appareil et le risque de tumeur maligne radio-induite (TMRI) subséquente préoc-cupe particulièrement chez les patients en pédiatrie. Dans cet article, les auteurs passent en revue les publications sur la pathophysiologie, la morbidité et la mortalité de l'appendicite, résument les données sur l'imagerie pédiatrique dans les cas d'appendicite, présentent une stratégie pratique d'imagerie pour les cliniciens qui évaluent des patients en pédiatrie et formulent des recommandations afin de réduire le risque de TMRI chez les patients en pédiatrie.

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Section: Ultrasoundmentioning

confidence: 99%

Pediatric appendicitis: pathophysiology and appropriate use of diagnostic imaging

Brennan

2006

CJEM

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“…41 The high sensitivity and specificity of CT scanning in AA made a case for regular use of CT scan in suspected AA including children, to improve patient care by reducing overall treatment cost, besides lowering the probability of negative appendectomy and perforation rates. 42,43 Many subsequent studies have reported superiority of CT scan over USG in the diagnosis and management of AA, [44][45][46][47] including modified techniques like 'Focused CT scan for appendix' to avoid needless radiation to the entire abdomen. While even non-contrast CT (NCCT) was found to be more accurate as compared to USG, contrast-enhanced CT scan with intravenous iodinated contrast and prior administration of oral contrast was found to improve diagnostic accuracy further when compared with NCCT.…”

Section: Ct Scanmentioning

confidence: 99%

Imaging in acute appendicitis: What, when, and why?

Debnath

George

Ravikumar

2017

Medical Journal Armed Forces India

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m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 3 ( 2 0 1 7 ) 7 4 -7 9 a r tLaboratory results are often non-specific. Imaging has an important role not only in diagnosing appendicitis and its complication but also suggesting alternate diagnosis in appropriate cases. However, there is no universally accepted diagnostic imaging algorithm for appendicitis. Imaging of acute appendicitis needs to be streamlined keeping pros and cons of the available investigative modalities. Radiography has practically no role today in the diagnosis and management of acute appendicitis. Ultrasonography (USG) should be the first line imaging modality for all ages, particularly for children and non-obese young adults including women of reproductive age group. If USG findings are unequivocal and correlate with clinical assessment, no further imaging is needed. In case of equivocal USG findings or clinico-radiological dissociation, follow-up/further imaging (computed tomography (CT) scan/magnetic resonance imaging (MRI)) is recommended. In pediatric and pregnant patients with inconclusive initial USG, MRI is the next option. Routine use of CT scan for diagnosis of AA needs to be discouraged. Our proposed version of a practical imaging algorithm, with USG first and always has been incorporated in the article. #

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“…3 Bununla birlikte, günümüzde çok kesitli bilgisayarlı tomografi (ÇKBT) yüksek duyarlılık ve özgüllük oranları nedeni ile akut apandisit tanısında altın standart olarak kabul edilmiştir. 4 Ancak ÇKBT, özellikle pediatrik hastalarda malignite insidansında artışa neden olduğu bilinen bir görüntüleme yöntemidir. Bu nedenle, ÇKBT'nin pediatrik hastalarda kullanımı yarar-zarar oranı iyi tanımlanmış belirgin klinik endikasyonlar ile sınırlandırılmalı-dır.…”

Section: Pediatrik Hastalarda Akut Apandisit Tanısı;unclassified

The Diagnosis of Acute Appendicitis in Pediatric Patients; the Influence of Abdominal Wall Fat Thickness on the Accuracy of Ultrasonography

Şafak¹

2017

Turkiye Klinikleri J Pediatr

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Imaging Evaluation of Suspected Appendicitis in a Pediatric Population

Abstract: Helical CT has a significantly higher sensitivity and accuracy than graded compression sonography for the diagnosis of appendicitis in a pediatric and young adult population, particularly in children more than 10 years old.

Cited by 136 publications

References 21 publications

Pediatric appendicitis: pathophysiology and appropriate use of diagnostic imaging

Pediatric appendicitis: pathophysiology and appropriate use of diagnostic imaging

Imaging in acute appendicitis: What, when, and why?

The Diagnosis of Acute Appendicitis in Pediatric Patients; the Influence of Abdominal Wall Fat Thickness on the Accuracy of Ultrasonography

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