Radiology pitfalls in the use of barium enema in pediatric appendicitis

Barium enema (BE) is usefull and safe in diagnosis of pediatric appendicitis, but pitfalls must be avoided. Reasons for false negative BE include failing to or inability to obtain good compression local views of the cecum and accepting a partially filled appendix as normal. In addition to right ovarian lesions in girls, there are less common causes of false positives, including mucocele, intussuscepted appendix, and recurrent inflammation of appendiceal stump. Non-filing of the appendix is not in itself abnormal. Abdominal ultrasound may be complementary, and increasingly is becoming the primary imaging modality for uncertain appendicitis.