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 — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Appendicitis is the most common condition in children requiring emergency abdominal surgery . The key to a successful outcome has always been early diagnosis followed by appendectomy before gangrene or perforation develops. Nevertheless, confirming the diagnosis of appendicitis and avoiding the risks of unnecessary surgery continue to be a challenge, particularly in young children .
Imaging plays an important role in the evaluation of patients who do not present with the classic signs and symptoms of appendicitis but in whom the diagnosis is being considered. Ultrasonography (US) and computed tomography (CT), separately or in combination, are the modalities used most frequently. In addition, there are data that suggest that using an imaging protocol improves diagnostic accuracy.
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'.)
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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