title: US examination of the appendix in children with suspected appendicitis: the additional value of secondary signs.
abstract: This study evaluated the additional value of secondary signs in the diagnosing of appendicitis in children with ultrasound. From May 2005 to June 2006, 212 consecutive paediatric patients with suspected appendicitis were examined. Ultrasonographic depiction of the appendix was classified into four groups: 1, normal appendix; 2, appendix not depicted, no secondary signs of appendicitis; 3, appendix not depicted with one of the following secondary signs: hyperechoic mesenteric fat, fluid collection, local dilated small bowel loop; 4, depiction of inflamed appendix. We classified 96 patients in group 1, 41 in group 2, 13 in group 3, and 62 in group 4. Prevalence of appendicitis was 71/212 (34%). Negative predictive values of groups 1 and 2 were 99% and 100%, respectively. Positive predictive values of groups 3 and 4 were 85% and 95%, respectively. In groups 3 and 4, hyperechoic mesenteric fat was seen in 73/75 (97.3%), fluid collections and dilated bowel loops were seen in 12/75 (16.0%) and 5/75 (6.6%), respectively. This study shows that in case of non-visualization of the appendix without secondary signs, appendicitis can be safely ruled out. Furthermore, secondary signs of appendicitis alone are a strong indicator of acute appendicitis.
authors.affiliation: Department of Radiology, Haga Teaching Hospital, Location Leyweg, Leyweg 275, 2545 CH The Hague, The Netherlands. Fwiersma80@hotmail.com
authors.forename: Fraukje
authors.initials: F
authors.lastname: Wiersma
authors.forename: Boudewijn R
authors.initials: BR
authors.lastname: Toorenvliet
authors.forename: Johan L
authors.initials: JL
authors.lastname: Bloem
authors.forename: Jan Hein
authors.initials: JH
authors.lastname: Allema
authors.forename: Herma C
authors.initials: HC
authors.lastname: Holscher
mesh_terms: D015746:Abdominal Pain; D000208:Acute Disease; D000293:Adolescent; D001064:Appendicitis / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D001065:Appendix / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*