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[Diagnostic role of echography in acute appendicitis in children]
R Perale1, E Talenti, T Toffolutti
1Istituto di Radiologia, Università, Padova.
Insights
High-resolution ultrasound (US) accurately diagnoses acute appendicitis in children, reducing unnecessary surgeries. This imaging technique aids in diagnosing equivocal cases, but false negatives require careful evaluation.
Area of Science:
- Pediatric Radiology
- Gastrointestinal Imaging
- Surgical Diagnostics
Background:
- Acute appendicitis is a common surgical emergency in children.
- Accurate diagnosis is crucial to avoid unnecessary laparotomies and delayed treatment.
- Ultrasound (US) is a widely used imaging modality for suspected appendicitis.
Purpose of the Study:
- To evaluate the diagnostic performance of high-resolution ultrasound with graded compression in pediatric patients with suspected acute appendicitis.
- To assess the impact of ultrasound on reducing negative appendectomy rates.
- To identify key ultrasound findings and patterns associated with different stages of appendicitis.
Main Methods:
- Eighty-seven pediatric patients with suspected acute appendicitis underwent high-resolution ultrasound with graded abdominal compression.
- Focus on patients with questionable clinical diagnosis (approx. 40% of all examined).
- Ultrasound findings were categorized into three patterns based on appendix visualization and associated abnormalities.
Main Results:
- Ultrasound demonstrated 87.3% accuracy, 81.5% sensitivity, and 90% specificity.
- Key findings included non-compressible appendix (≥5 mm diameter), wall thickening, appendicoliths, and altered echogenic layers.
- Ultrasound reduced unnecessary laparotomies by approximately two-thirds compared to pre-ultrasound periods.
Conclusions:
- High-resolution ultrasound is effective in diagnosing acute appendicitis and periappendiceal abscesses in children, especially in clinically equivocal cases.
- The technique significantly decreases the rate of negative appendectomies.
- Careful clinical and ultrasound evaluation is necessary for equivocal cases with atypical ultrasound patterns due to the incidence of false negatives.
Abstract:
Eighty-seven pediatric patients with suspected acute appendicitis underwent high-resolution US with graded abdominal compression. The study was limited to the patients with a questionable clinical diagnosis, accounting for about 40% of the patients examined for acute appendicitis in our Institution. US had 87.3% accuracy, 81.5% sensitivity, and 90% specificity. The main US findings in the positive cases were: visualization of the appendix as a tubular non-compressible structure, with a diameter of 5 mm or more, symmetric/asymmetric wall thickening, possible presence of appendicoliths and variable appearance of the central echogenic layer (preserved, doubled for lumen dilatation, partially/totally lost). The above US findings were grouped in 3 basic patterns: type I (thickened appendix with no structural abnormalities) appeared to be related to non-suppurative and phlegmonous acute appendicitis; type II (detectable appendiceal abnormalities) was observed both in phlegmonous and in suppurative acute appendicitis; type III (pericecal complex mass, frequently with appendicoliths) was found in all cases of periappendiceal abscess. In our experience, the use of US in the diagnosis of acute appendicitis in children allowed a reduction by about 2/3 in the rate of unnecessary laparotomies. Such a finding emerges from the comparison with the results obtained in the 2 years prior to the use of US. The technique also allowed an unquestionable diagnosis of acute appendicitis or periappendiceal abscess to be made in a number of clinically equivocal cases, thus avoiding potentially harmful delays in diagnosis. On the other hand, the incidence of false-negatives on US is not negligible, which calls for a cautious clinical and US evaluation of all equivocal cases following no typical US pattern.