Abstract:
BACKGROUND:There is strong evidence that imaging with ultrasound and CT can be of substantial diagnostic value in the diagnosis of acute appendicitis in children, but there is limited information of the impact of imaging on the management of these patients and its possible effect on surgical findings. OBJECTIVE:We studied the impact of imaging in the management of acute appendicitis, in particular its effect on the rate of negative appendectomies and perforations. PATIENTS AND METHODS:We reviewed retrospectively the clinical records and imaging findings of 633 consecutive children and adolescents seen on an emergency basis with clinical suspicion of acute appendicitis. Two hundred seventy patients were operated upon on clinical evidence alone, while 360 were referred for US or CT, and occasionally both, because of doubtful clinical findings. RESULTS:Acute appendicitis was found in 237 of those on clinical grounds alone, 68 of whom had perforation and related complications. Thus the rate of negative exploration and the rate of perforation were13 % and 29 %, respectively. One hundred eighty-two patients had preoperative US (sensitivity 74 %, specificity 94 %), 119 had CT (sensitivity 84 %, specificity 99 %), and 59 had both US and CT (sensitivity 75 %, specificity 100 %, but often with interpretation at variance with each other). The rate of negative appendectomy and perforation was 8 % and 23 %, respectively, for US, 5 % and 54 % for CT, and 9 % and 71 % when both examinations were performed. There is no statistical significance between the rates of diagnostic performance of US, CT, or their combination, nor between the negative appendectomy rates of each group, but the rate of perforation was significantly higher when CT was performed, alone or after US. CONCLUSION:The retrospective nature of the study prevents precise definition of the clinical characteristics and selection criteria for diagnostic examinations that may contribute to the management of children with suspected acute appendicitis. It was designed, however, to reflect the diagnostic approach and management of these patients, under the care of many decision makers and interpreters of imaging examinations, prevalent today in most hospital-based clinical practices. It is suggested that imaging increases diagnostic accuracy in difficult cases, but it might be one of the factors increasing the rate of perforations.
journal_name
Pediatr Radioljournal_title
Pediatric radiologyauthors
Karakas SP,Guelfguat M,Leonidas JC,Springer S,Singh SPdoi
10.1007/s002470050023keywords:
subject
Has Abstractpub_date
2000-02-01 00:00:00pages
94-8issue
2eissn
0301-0449issn
1432-1998pii
00300094.247journal_volume
30pub_type
杂志文章abstract::Imaging is often a fundamental part in the evaluation of an injured or ill child. A variety of imaging modalities (radiography, angiography/fluoroscopy, sonography, CT, magnetic resonance imaging and scintigraphy) are among the options. CT is worth focused attention because of its usefulness in a variety of emergency ...
journal_title:Pediatric radiology
pub_type: 杂志文章,评审
doi:10.1007/s00247-008-0863-4
更新日期:2008-11-01 00:00:00
abstract::We present a case of neonatal acute gastric outlet obstruction related to prostaglandin-induced gastric foveolar hyperplasia, which developed following infusion of prostaglandin E1 (PGE1) for treatment of hypoplastic left heart syndrome. Abdominal distension occurred after administration of PGE1 in a cumulative dose o...
journal_title:Pediatric radiology
pub_type: 杂志文章
doi:10.1007/s002470050064
更新日期:1997-01-01 00:00:00
abstract::The technique of inversion-ligation appendectomy is used by some surgeons to eliminate the risk of peritoneal contamination as the result of incidental appendectomy during an otherwise clean surgical procedure. In most cases, the intussuscepted appendix necroses and sloughs into the cecum after several days. We presen...
journal_title:Pediatric radiology
pub_type: 杂志文章
doi:10.1007/s002470100492
更新日期:2001-08-01 00:00:00
abstract::Suspected appendicitis is the most common indication for emergent abdominal surgery in children. The clinical diagnosis of appendicitis can be challenging, and CT is playing an increasing role in the evaluation of right lower quadrant pain. Occasionally, alternative diagnoses to appendicitis can be suggested on CT. Th...
journal_title:Pediatric radiology
pub_type: 杂志文章,评审
doi:10.1007/s00247-008-1110-8
更新日期:2009-04-01 00:00:00
abstract::Hardcastle syndrome is a rare, autosomally dominant inherited skeletal dysplasia, characterized by diaphyseal sclerosis, medullary stenosis, pathological fractures, bony infarction, and malignant transformation. A 19-year-old proband is presented and discussed, adding a fourth family to the world literature. Radiograp...
journal_title:Pediatric radiology
pub_type: 杂志文章
doi:10.1007/BF01356833
更新日期:1996-09-01 00:00:00
abstract:OBJECTIVES:Questionnaires (984) were submitted to pediatric radiologists to determine how often odontoid fractures were missed on lateral views and detected on open-mouth odontoid views in children under 5 years. Other questions relating to imaging protocols of the odontoid also were included, and there were 432 respon...
journal_title:Pediatric radiology
pub_type: 杂志文章
doi:10.1007/s002470050043
更新日期:2000-03-01 00:00:00
abstract::Two cases of intussusception with free peritoneal fluid detected by ultrasound are presented. In neither of these cases was the fluid associated with perforation or intestinal compromise. After assessing the findings in these patients, we believe that small amounts of fluid may well be present in uncomplicated intussu...
journal_title:Pediatric radiology
pub_type: 杂志文章
doi:10.1007/BF02011484
更新日期:1991-01-01 00:00:00
abstract::A variety of problems can arise while performing MR arthrography of the shoulder. These have been well documented in the literature and range from improper patient selection to errors in technique or in the choice of imaging sequences. We present a rare case of inadvertent, painless intraosseous injection of dilute ga...
journal_title:Pediatric radiology
pub_type: 杂志文章
doi:10.1007/s00247-008-0828-7
更新日期:2008-07-01 00:00:00
abstract::The logistic approach in diagnosis of focal nodular hyperplasia (FNH) of the liver is discussed, based on the experience with three children. In only one child could the diagnosis be made without angiography. In that child the combination of hypervascularity on the radionuclide angiogram and uptake of the radiocolloid...
journal_title:Pediatric radiology
pub_type: 杂志文章
doi:10.1007/BF02390106
更新日期:1983-01-01 00:00:00
abstract::We retrospectively reviewed the imaging and surgical findings in 17 patients with duodenal atresia to determine (a) the frequency of coexistent malrotation in patients with duodenal atresia and (b) the reliability of the upper gastrointestinal barium study (UGI) in differentiating malrotation from postoperative deform...
journal_title:Pediatric radiology
pub_type: 杂志文章
doi:10.1007/BF02012180
更新日期:1994-01-01 00:00:00
abstract::The need for X-ray investigations of the urinary tract at the time of the first proven urinary infection, even in older girls, is stressed. This policy is the best way to detect chronic pyelonephritis and congenital anomalies of the urinary tract and provide timely and appropriate treatment. These conclusions are supp...
journal_title:Pediatric radiology
pub_type: 杂志文章
doi:10.1007/BF00972109
更新日期:1977-10-28 00:00:00
abstract::ACTH is used in childhood to treat infantile spasms and acute cerebellar encephalopathy (opsoclonus-cerebellar ataxia syndrome). We report two infants with ultrasonographic and CT evidence of massive, reversible adrenal enlargement secondary to exogenous ACTH therapy for these disorders. ...
journal_title:Pediatric radiology
pub_type: 杂志文章
doi:10.1007/BF02012450
更新日期:1993-01-01 00:00:00
abstract::Abnormal enlargement or malposition of any vascular structure or mass adjacent to the airway can cause extrinsic airway compression. In children with previous surgery for congenital heart disease, mass effect from prosthetic devices or alteration in the anatomic position of normal structures can lead to extrinsic airw...
journal_title:Pediatric radiology
pub_type: 杂志文章
doi:10.1007/s002470050121
更新日期:1997-03-01 00:00:00
abstract::We describe a 4-year-old girl with an inflammatory pseudotumour of the pancreas, which was preceded by varicella-zoster infection. Inflammatory pseudotumour may involve a variety of tissues, the lungs and liver being typical sites of predilection. Imaging and laboratory tests are nonspecific, and for this reason the d...
journal_title:Pediatric radiology
pub_type: 杂志文章
doi:10.1007/s002470000331
更新日期:2000-11-01 00:00:00
abstract:BACKGROUND:Size-specific dose estimate is gaining increased acceptance as the preferred index of CT dose in children. However it was developed based on non-clinical data. OBJECTIVE:To compare the accuracy of size-specific dose estimate (SSDE) based on geometric and body weight measures in pediatric chest and abdomen C...
journal_title:Pediatric radiology
pub_type: 杂志文章
doi:10.1007/s00247-016-3604-0
更新日期:2016-08-01 00:00:00
abstract::In the context of health care, risk assessment is the identification, evaluation and estimation of risk related to a particular clinical situation or intervention compared to accepted medical practice standards. The goal of risk assessment is to determine an acceptable level of risk for a given clinical treatment or i...
journal_title:Pediatric radiology
pub_type: 杂志文章,评审
doi:10.1007/s00247-017-4023-6
更新日期:2018-01-01 00:00:00
abstract::Large-cell calcifying Sertoli cell tumors are exceedingly rare testicular tumors which can be distinguished from pure Sertoli cell tumors by distinctive microscopic features and multifocal and bilateral calcifications [1]. We describe the characteristic sonographic appearance of the tumor with pathologic correlation. ...
journal_title:Pediatric radiology
pub_type: 杂志文章
doi:
更新日期:1995-11-01 00:00:00
abstract:BACKGROUND:Hepatic involvement is frequent in patients with cystic fibrosis (CF), with focal biliary cirrhosis being the pathognomonic hepatic manifestation. In around one-quarter of CF patients, it results in CF-associated liver disease (CFLD). This occurs as a relatively early complication with the majority of patien...
journal_title:Pediatric radiology
pub_type: 杂志文章
doi:10.1007/s00247-009-1531-z
更新日期:2010-07-01 00:00:00
abstract:BACKGROUND:Late-onset noninfectious pulmonary complications (LONIPCs) are life-threatening complications of bone marrow transplantation (BMT). Several pathological patterns are described in the literature with different prognoses, and with different relationships to graft-versus-host disease (GVHD). The role of high-re...
journal_title:Pediatric radiology
pub_type: 杂志文章
doi:10.1007/s00247-008-0984-9
更新日期:2008-11-01 00:00:00
abstract:BACKGROUND:Hirschsprung disease (HD) is a functional obstruction of the bowel caused by the absence of intrinsic enteric ganglion cells. The diagnosis of total colonic HD (TCHD) based on contrast enemas is difficult in newborns because radiological findings vary. OBJECTIVE:To evaluate the radiographic and contrast ene...
journal_title:Pediatric radiology
pub_type: 杂志文章
doi:10.1007/s00247-008-0952-4
更新日期:2008-11-01 00:00:00
abstract::The experience from 123 pediatric MRI examinations disclosed several different types of artifacts and age-related variants that could have caused pitfalls in MRI interpretation. Artifacts were caused by metallic objects, patient touching the RF coil, and patient motion. The potential pitfalls are caused by the MRI var...
journal_title:Pediatric radiology
pub_type: 杂志文章
doi:10.1007/BF02388605
更新日期:1985-01-01 00:00:00
abstract::Pericardial involvement in chronic granulomatous disease (CGD) is very rare. We present two children with known CGD and pericardial effusions in whom no microbial cause for the effusions was found. ...
journal_title:Pediatric radiology
pub_type: 杂志文章
doi:10.1007/s002470050704
更新日期:1999-11-01 00:00:00
abstract::A case of hypertrophic osteoarthropathy in a 5-year-old Saudi boy is presented. The child developed painful joints, was found to have clubbing of fingers and radiologically hypertrophic osteoarthropathy was demonstrated. The underlying cause of the condition was ingestion of animal fat in infancy, with a history of gh...
journal_title:Pediatric radiology
pub_type: 杂志文章
doi:10.1007/BF02019076
更新日期:1995-01-01 00:00:00
abstract::Two patients with different patterns of soft tissue and bone involvement demonstrate the variability of extracutaneous manifestations of juvenile xanthogranuloma, a non-X histiocytosis, better known to dermatologists than to radiologists. ...
journal_title:Pediatric radiology
pub_type: 杂志文章,评审
doi:10.1007/BF02016261
更新日期:1992-01-01 00:00:00
abstract::Magnetic resonance imaging has been used to evaluate 10 children with lymphomas and was able to identify disease in all 10 cases and monitor response to therapy in all three patients with follow-up studies. It could not distinguish between the different histological types of lymphoma. The image intensity of a diseased...
journal_title:Pediatric radiology
pub_type: 杂志文章
doi:10.1007/BF02388606
更新日期:1985-01-01 00:00:00
abstract::Three very low birth weight infants, treated with frusemide for broncho-pulmonary dysplasia are described. They all developed medullary nephrocalcinosis identifiable by real time ultrasound. The sonographic findings of diffuse medullary hyper-echogenicity appears to be specific for nephrocalcinosis. ...
journal_title:Pediatric radiology
pub_type: 杂志文章
doi:10.1007/BF02389002
更新日期:1988-01-01 00:00:00
abstract:PURPOSE:A retrospective study was carried out in order to determine the role of sonography in establishing the diagnosis in extremity osteomyelitis. MATERIALS AND METHODS:The imaging documents of 24 infants and children aged from 2 weeks to 13 years with osteomyelitis (acute 21, chronic 3) were reviewed. Sonograms and...
journal_title:Pediatric radiology
pub_type: 杂志文章
doi:10.1007/BF01372116
更新日期:1996-01-01 00:00:00
abstract::Abnormalities of the fetal urinary tract, most commonly hydronephrosis of differing causes, can be detected by ultrasound (US). Prenatal measurements of the kidney can help to predict the postnatal outcome of hydronephrosis. About 20% of abnormalities evident in utero are not present after birth. After delivery, vario...
journal_title:Pediatric radiology
pub_type: 杂志文章,评审
doi:10.1007/s002470050434
更新日期:1998-08-01 00:00:00
abstract::The neurosonograms of fifty-eight patients treated over a four-year period with ECMO support were retrospectively reviewed for analysis of changes in interhemispheric (IHF) width while on ECMO. To correlate these measurements with patterns of development of total body edema as reflected by chest wall thickening on por...
journal_title:Pediatric radiology
pub_type: 杂志文章
doi:10.1007/BF02010805
更新日期:1990-01-01 00:00:00
abstract::Many heritable disorders of the skeleton are transmitted as autosomal recessive (AR) traits. During the past two decades, family studies have been undertaken in conditions of this type in order to detect any structural manifestations in obligate and potential heterozygotes. The positive findings that emerge from this ...
journal_title:Pediatric radiology
pub_type: 杂志文章,评审
doi:10.1007/s002470050155
更新日期:1997-05-01 00:00:00