ABSTRACT
Introduction:
To draw attention to possible causes of atypical radiological condition with a “secondary view” in atypical pediatric acute appendicitis cases. To offer solutions in order to minimize possible false negative ultrasonographic evaluation in atypical cases.
Materials and Methods:
51 cases were included in this retrospective study. These cases were referred to our hospital because of an atypical acute appendicitis clinic, although ultrasonography was interpreted as normal in other centers in the last 24 hours. All cases were operated on with the diagnosis of acute appendicitis by “second look ultrasonography” performed in our department.
Results:
None of the cases had typical acute appendicitis clinic. Reasons such as perforation/plastron of the appendix, an atypical localization of the appendix, inflammation only in the distal part of the appendix, visualization of the appendix only with deep-compression, and failure to establish adequate communication with the patient for various reasons were conditions that could lead to atypical acute appendicitis and make imaging difficult. One or more of these were present in all cases.
Conclusion:
The potential diagnostic difficulties that may lead to a false-negative assessment in any case of atypical acute appendicitis should be well recognized. For an accurate ultrasonographic diagnosis, possible atypical localizations should be checked, and “deep-compression” should be used in addition to graded-compression.
Keywords:
Ultrasound, appendicitis, appendix
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