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When appendicitis is suspected in children
C J Sivit1, M J Siegel, K E Applegate
1Department of Radiology, Rainbow Babies and Children's Hospital of the University Hospitals of Cleveland and Case Western Reserve School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106-5056, USA. sivit@uhrad.com
Insights
Diagnosing acute appendicitis in children can be challenging due to atypical presentations. Imaging like ultrasound and CT scans are crucial for accurate diagnosis and preventing serious complications.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
Background:
- Acute appendicitis is the most common surgical emergency in children.
- Delayed diagnosis leads to severe complications like perforation, sepsis, and death.
- Clinical diagnosis is often difficult due to atypical presentations in about one-third of pediatric cases.
Purpose of the Study:
- To review the utility of cross-sectional imaging modalities for diagnosing acute appendicitis in children.
- To compare the advantages and disadvantages of ultrasonography (US) and computed tomography (CT) in pediatric appendicitis evaluation.
Main Methods:
- Review of existing literature on ultrasonography and computed tomography for pediatric appendicitis.
- Analysis of diagnostic accuracy, cost, radiation exposure, and operator dependency of US and CT.
Main Results:
- Both ultrasonography (US) and computed tomography (CT) are valuable for evaluating suspected acute appendicitis in children.
- US offers advantages such as lower cost, no ionizing radiation, and dynamic assessment.
- CT provides higher diagnostic accuracy, is less operator-dependent, and better delineates disease extent in perforated cases.
Conclusions:
- Imaging plays a critical role in the timely and accurate diagnosis of acute appendicitis in pediatric patients.
- The choice between US and CT depends on clinical context, institutional resources, and specific diagnostic needs.
- Optimizing the use of these imaging modalities is essential to reduce delayed diagnoses and associated morbidity in children.
Abstract:
Acute appendicitis is the most common condition requiring emergent abdominal surgery in childhood. The clinical diagnosis of acute appendicitis is often not straightforward because approximately one-third of children with the condition have atypical clinical findings. The delayed diagnosis of this condition has serious consequences, including appendiceal perforation, abscess formation, peritonitis, sepsis, bowel obstruction, and death. Cross-sectional imaging with ultrasonography (US) and computed tomography (CT) have proved useful for the evaluation of suspected acute appendicitis. There has been a great deal of variability in the utilization of these modalities for such diagnosis in the pediatric population. The principal advantages of US are its lower cost, lack of ionizing radiation, and ability to assess vascularity through color Doppler techniques and to provide dynamic information through graded compression. The principal advantages of CT include less operator dependency than US, as reflected by a higher diagnostic accuracy, and enhanced delineation of disease extent in a perforated appendix.