Sonography of acute appendicitis in childhood: perforation versus nonperforation

Hayden, C. K.; Kuchelmeister, J; Lipscomb, Thomas S.

doi:10.7863/jum.1992.11.5.209

Cited by 56 publications

(26 citation statements)

References 14 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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“…Ultrasound is increasingly being utilized in the investigation of acute abdominal problems in infants and children (1)(2)(3)(4)(5)(6) and is playing a greater and greater role in the diagnosis of appendicitis (8)(9)(10)(11)(12)(13)(14)(15)(16) and intussusception (17)(18)(19)(20)(21)(22). It also is useful in the detection of other surgical conditions.…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasonography was positive in all but one of these cases, resulting in a detection rate of 95%. The diagnosis of appendicitis was accomplished according to well-established criteria (7)(8)(9)(10)(11)(12)(13)(14)(15)(16); the incidence of the various findings is documented in Table 4. With respect to intussusception, ultrasonography correctly diagnosed all 14 cases, supporting published findings (17)(18)(19)(20)(21)(22) that ultrasound is highly effective in detecting or excluding intussusception.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound in the acute pediatric abdomen: How accurate is it for surgical conditions?

Allbery

McNees

Swischuk

et al. 1996

Emergency Radiology

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The ultrasonographic and clinical findings in 295 consecutive patients undergoing ultrasound evaluation for abdominal complaints were retrospectively reviewed. The objective of the study was to determine the accuracy and validity of ultrasound in differentiating surgical from nonsurgical acute abdominal conditions. Our results demonstrated that ultrasound was 95 % accurate in detecting surgical conditions. As a result, ultrasound is recommended as a satisfactory imaging modality for differentiating acute surgical from nonsurgical abdominal problems in children. A cute abdominal pain is a common problem in pediatric patients, and, in such cases, it is vital to differentiate surgical from nonsurgical conditions. The need for surgery traditionally has been determined on a clinical rather than imaging basis, but, with the increasing utilization of ultrasound in the evaluation of acute abdominal problems (1-6), this concept is changing. Ultrasound is now commonly employed in the investigation of acute appendicitis (7-16) and in the evaluation of intussusception (17)(18)(19)(20)(21)(22). Cumulative data from these publications support the effectiveness of ultrasound in detecting these two conditions, but none of the studies specifically addresses whether ultrasound is effective overall in differentiating surgical from uonsurgical causes of acute abdominal problems in infants and children. For this reason, we undertook our study. MATERIALS AND METHODSThe ultrasonographic and clinical findings in 295 consecutive patients undergoing ultrasound examination for acute abdominal problems were reviewed. Sixty-two patients with chronic abdominal pain (that is, pain occurring for over 1 month) were excluded. Thus, the total number of patients studied was 233. There were 101 males and 132 females, and the age range was from 3 weeks to 14 years, with a mean of 10.1 years. All of the studies were performed on U1-tramark 9 HDI ultrasound units utilizing both sector and high-resolution linear (7.5-10 MHz) scanners. For each patient, the diagnosis documented on the official report at the time of initial examination was compared with the final clinical diagnosis. All of the patients were referred for examination to confirm a suspected diagnosis or to establish a diagnosis in puzzling cases. RESU LTSClinical examination of the 233 patients revealed that 55 patients had a surgical condition, and 178 patients had a nonsurgical condition. The ultrasound examination was normal in 3 of 55 patients (5%) with a surgical abdomen and in 119 of 178 patients (67%) with a nonsurgical abdomen. It was abnormal in 52 of the 55 patients (95%) with a surgical abdomen and normal in 59 of 78 (33%) patients with a nonsurgical abdomen (Tables 1 and 2). Of the 178 patients with nonsurgical conditions, 66 had a variety of gastrointestinal disorders, 102 • Ultrasound in Acute Pediatric Abdomen Emergency Radiology •

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“…7). The fluid previously trapped within the appendix is often expelled after perforation, leaving a collapsed appendix that can be more difficult to visualize with both US and CT [30] (Fig. 8A).…”

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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Sonography of acute appendicitis in childhood: perforation versus nonperforation

Cited by 56 publications

References 14 publications

Pediatric appendicitis: pathophysiology and appropriate use of diagnostic imaging

Pediatric appendicitis: pathophysiology and appropriate use of diagnostic imaging

Ultrasound in the acute pediatric abdomen: How accurate is it for surgical conditions?

The use of advanced imaging for appendicitis in children

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