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Acute appendicitis in children: Diagnostic imaging

George A Taylor, MD
David E Wesson, MD
Section Editor
Jonathan I Singer, MD
Deputy Editor
James F Wiley, II, MD, MPH


This topic will review diagnostic imaging for acute appendicitis in children. The epidemiology, clinical features, diagnosis, and treatment of appendicitis in children are discussed separately. (See "Acute appendicitis in children: Clinical manifestations and diagnosis" and "Acute appendicitis in children: Management".)


The decision to perform imaging in the diagnostic evaluation of children with abdominal pain is determined by clinical findings and the setting as follows (algorithm 1):

Low clinical likelihood of appendicitis – Imaging is not warranted in most children who are unlikely to have appendicitis based upon the clinical examination and laboratory studies. (See "Acute appendicitis in children: Clinical manifestations and diagnosis", section on 'Clinical suspicion'.)

Incomplete or equivocal findings for appendicitis For children who have atypical or equivocal findings for appendicitis on physical examination and laboratory testing, imaging may be helpful to establish or exclude the diagnosis. Imaging may also be needed for patients who have received antibiotics prior to evaluation. Ultrasonography (US) and computed tomography (CT), separately or in combination, are the modalities used most frequently although magnetic resonance imaging has similar diagnostic accuracy as CT. (See 'Imaging approach' below and "Acute appendicitis in children: Clinical manifestations and diagnosis", section on 'Clinical suspicion'.)

High clinical likelihood of appendicitis – We suggest that children with a high likelihood of appendicitis based upon clinical findings undergo evaluation by a surgeon with pediatric expertise prior to urgent imaging studies. (See "Acute appendicitis in children: Clinical manifestations and diagnosis", section on 'Clinical suspicion'.)

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Literature review current through: Nov 2017. | This topic last updated: Jan 03, 2017.
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