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

References

Lee SL, Ku YM, Choi BG, Byun JY. In Vivo Location of the Vermiform Appendix in Multidetector CT. J Korean Soc Radiol 2014;70:283-9.

Vieira EPL, Bonato LM, Silva GGP, Gurgel JL. Congenital abnormalities and anatomical variations of the vermiform appendix and mesoappendix. J Coloproctol 2019;39:279-87.

Zacharzewska-Gondek A, Szczurowska A, Guziński M, Sąsiadek M, Bladowska J. A pictorial essay of the most atypical variants of the vermiform appendix position in computed tomography with their possible clinical implications. Pol J Radiol 2019;84:e1-e8.

Karagülle E, Türk E, Yildirim E, Moray G. A rare cause of left lower quadrant abdominal pain: acute appendicitis with situs inversus totalis. Ulus Travma Acil Cerrahi Derg 2010;16:268-70.

Palabıyık F, Kayhan A, Cimilli T, Toksoy N, Bayramoğlu S, Aksoy S. Çocuk apandisitlerinde direkt batın grafisi ile ultrason bulgularının karşılaştırılması. Marmara Med J 2008;21:203-9.

The efficacy of nonenhanced computed tomography in the diagnosis of acute appendicitis. Ortadoğu Tıp Dergisi 2018;119-24.

Old JL, Dusing RW, Yap W, Dirks J. Imaging for suspected appendicitis. Am Fam Physician 2005;71:71-8.

Himeno S, Yasuda S, Oida Y, Mukoyama S, Nishi T, Mukai M, et al. Ultrasonography for the diagnosis of acute appendicitis. Tokai J Exp Clin Med 2003;28:39-44.

Howell EC, Dubina ED, Lee SL. Perforation risk in pediatric appendicitis: assessment and management. Pediatric Health Med Ther 2018;9:135-45.

Janitz E, Naffaa L, Rubin M, Ganapathy S. Ultrasound Evaluation for Appendicitis Focus on the Pediatric Population: A Review of the Literature. J Am Osteopath Coll Radiol 2016;5:5-14.

Quigley AJ, Stafrace S. Ultrasound assessment of acute appendicitis in paediatric patients: methodology and pictorial overview of findings seen. Insights Imaging 2013;4:741-51.

Taşar S, Taşar MA, Ayyıldız NK, Güder L, Arıkan Fİ, Dallar YB. The Importance of the Pediatric Appendicitis Score and Ultrasonographic Findings for the Diagnosis of Acute Appendicitis in the Pediatric Emergency Department. Turk J Pediatr Dis 2015;9:184-8.

Blumfield E, Nayak G, Srinivasan R, Muranaka MT, Blitman NM, Blumfield A, et al. Ultrasound for differentiation between perforated and nonperforated appendicitis in pediatric patients. AJR Am J Roentgenol 2013;200:957-62.

Hoffmann JC, Trimborn CP, Hoffmann M, Schröder R, Förster S, Dirks K, et al. Classification of acute appendicitis (CAA): treatment directed new classification based on imaging (ultrasound, computed tomography) and pathology. Int J Colorectal Dis 2021;36:2347-60.

Piyarom P, Kaewlai R. False-negative appendicitis at ultrasound: nature and association. Ultrasound Med Biol 2014;40:1483-9.

Yildiz H, Okay ST, Yildirim E, Beskardesler N. A pin detected by ultrasonography within the normal appendix: prior to surgery, an impressive use of ultrasonography to localize an ingested foreign body exactly. J Ultrasound 2021;24:525-8.

Uner C, Karaman I. Paracolic Lymph Nodes: A Novel Diagnostic Sign For Pediatric Perforated Appendicitis? Turkish J Pediatr Dis 2020;14:366-70.

Gür HÜ, Görmüş C, Çıtlak G, Yüksel S, Ferlengez E, Erözgen F. The Place of Ultrasonography and Alvarado Scoring System in the Diagnosis of Acute Appendicitis. Med Bull Haseki 2019;57:135-41.

Yu D, Gu C, Zhang S, Yang H, Yao T. Ultrasound features and the diagnostic strategy of subhepatic appendicitis. Ann Transl Med 2020;8:1083.

Algın O, Özmen E, Özcan AS, Erkekel Ş, Karaoğlanoğlu M. Unusual manifestation of acute retrocecal appendicitis: pericholecystic fluid. Ulus Travma Acil Cerrahi Derg 2013;19:80-2.

Hong GS, Lee CW, Kim MH, Kim C. Appendiceal location analysis and review of the misdiagnosis rate of appendicitis associated with deep pelvic cecum on multidetector computed tomography. Clin Imaging 2016;40:714-9.

Pediatrik Atipik Akut Apandisitte Ultrasonografik İkincil Bakı

ABSTRACT

References