Acute appendicitis in children: Diagnostic imaging
- George A Taylor, MD
George A Taylor, MD
- John A Kirkpatrick Professor of Radiology (Pediatrics)
- Harvard Medical School
- David E Wesson, MD
David E Wesson, MD
- Professor of Surgery
- Baylor College of Medicine
- Section Editor
- Jonathan I Singer, MD
Jonathan I Singer, MD
- Section Editor — Pediatric Surgical Emergencies
- Professor of Emergency Medicine and Pediatrics
- Wright State University Boonshoft School of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
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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- IMAGING DECISION
- IMAGING APPROACH
- ULTRASONOGRAPHY (US)
- Test performance
- Pitfalls and limitations of US
- Sonographic findings
- COMPUTED TOMOGRAPHY (CT)
- Test performance
- - Contrast
- - Focused CT
- - CT scanning parameters
- Pitfalls and limitations of CT
- CT findings
- MAGNETIC RESONANCE IMAGING (MRI)
- PLAIN RADIOGRAPHS
- CLINICAL PROTOCOLS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS