The non-diagnostic ultrasound in appendicitis: is a non-visualized appendix the same as a negative study?

Cohen, Brian D.; Bowling, Jordan; Midulla, Peter; Shlasko, Edward; Lester, Neil; Rosenberg, Henrietta Kotlus; Lipskar, Aaron M.

doi:10.1016/j.jpedsurg.2015.03.012

Cited by 66 publications

(48 citation statements)

References 23 publications

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“…Our study demonstrates that secondary signs noted on US are associated with appendicitis and improve the overall accuracy of equivocal US studies to that of unequivocal US studies. Our appendix visualization rate of 36% is similar to recently published rates 11,12,16,17 . With non-visualization of the appendix, an equivocal imaging report creates a diagnostic dilemma.…”

Section: 0 Discussionsupporting

confidence: 90%

“…In effort to increase the diagnostic accuracy of equivocal US, investigations have proposed combining equivocal studies with additional data such as laboratory values or sonographic secondary signs of appendicitis 16,17,23–25 . Prior studies have evaluated if the presence or absence of SS in equivocal US studies could differentiate a positive and negative US 23,24,26 .…”

Section: 0 Discussionmentioning

confidence: 99%

“…The user-dependency of US is reflected by a wide appendix visualization rate ranging from 40% to 89% 12–16 . Furthermore, differences in intra-institutional appendix visualization rates exist depending on whether the study is performed by a pediatric radiologist or a pediatric radiology technologist (75% vs 54%) 17 . When the appendix is visualized, US typically has a sensitivity (SN) ranging from 86% to 100% and specificity (SP) ranging from 88 to 98% 1,10,13,18 .…”

Section: 0 Backgroundmentioning

confidence: 99%

“…In addition to the expense of CTs, CTs expose children to ionizing radiation, increasing their risk of subsequent cancer development 9,20–22 . In effort to increase the diagnostic accuracy of US, investigators have proposed combining equivocal US studies with additional data such as laboratory values or sonographic secondary signs of appendicitis 16,17,23–25 . These results have not been widely validated, and the clinical utility of secondary signs has not been generally accepted.…”

Section: 0 Backgroundmentioning

confidence: 99%

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Secondary signs may improve the diagnostic accuracy of equivocal ultrasounds for suspected appendicitis in children

Partain

Patel

Travers

et al. 2016

Journal of Pediatric Surgery

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Introduction Ultrasound (US) is the preferred imaging modality for evaluating appendicitis. Our purpose was to determine if including secondary signs (SS) improves diagnostic accuracy in equivocal US studies. Methods Retrospective review identified 825 children presenting with concern for appendicitis and with a right lower quadrant (RLQ) US. Regression models identified which SS were associated with appendicitis. Test characteristics were demonstrated. Results 530 patients (64%) had equivocal US reports. Of 114 (22%) patients with equivocal US undergoing CT, those with SS were more likely to have appendicitis (48.6% vs 14.6%, p<0.001). Of 172 (32%) patients with equivocal US admitted for observation, those with SS were more likely to have appendicitis (61.0% vs 33.6%, p<0.001). SS associated with appendicitis included fluid collection (adjusted odds ratio (OR) 13.3, 95% Confidence Interval (CI) 2.1–82.8), hyperemia (OR=2.0, 95%CI 1.5–95.5), free fluid (OR=9.8, 95%CI 3.8–25.4), and appendicolith (OR=7.9, 95%CI 1.7–37.2). Wall thickness, bowel peristalsis, and echogenic fat were not associated with appendicitis. Equivocal US that included hyperemia, a fluid collection, or an appendicolith had 96% specificity and 88% accuracy. Conclusion Use of SS in RLQ US assists in the diagnostic accuracy of appendicitis. SS may guide clinicians and reduce unnecessary CT and admissions.

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confidence: 90%

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confidence: 99%

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confidence: 99%

Section: 0 Backgroundmentioning

confidence: 99%

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Secondary signs may improve the diagnostic accuracy of equivocal ultrasounds for suspected appendicitis in children

Partain

Patel

Travers

et al. 2016

Journal of Pediatric Surgery

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“…Children at low risk for appendicitis with equivocal ultrasound findings are amenable to observation and reassessment [59] . When the patient's white blood cell count is < 11.0 × 10 9 /L, a non-diagnostic ultrasound or non-visualized appendix on ultrasound are associated with negative predictive values of 95.59% and 96.99%, respectively [61] .…”

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confidence: 99%

Abdominal ultrasonography of the pediatric gastrointestinal tract

Gale¹,

Gee²,

Westra³

et al. 2016

WJR

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Ultrasound is an invaluable imaging modality in the evaluation of pediatric gastrointestinal pathology; it can provide real-time evaluation of the bowel without the need for sedation or intravenous contrast. Recent improvements in ultrasound technique can be utilized to improve detection of bowel pathology in children: Higher resolution probes, color Doppler, harmonic and panoramic imaging are excellent tools in this setting. Graded compression and cine clips provide dynamic information and oral and intravenous contrast agents aid in detection of bowel wall pathology. Ultrasound of the bowel in children is typically a targeted exam; common indications include evaluation for appendicitis, pyloric stenosis and intussusception. Bowel abnormalities that are detected prenatally can be evaluated after birth with ultrasound. Likewise, acquired conditions such as bowel hematoma, bowel infections and hernias can be detected with ultrasound. Rare bowel neoplasms, vascular disorders and foreign bodies may first be detected with sonography, as well. At some centers, comprehensive exams of the gastrointestinal tract are performed on children with inflammatory bowel disease and celiac disease to evaluate for disease activity or to confirm the diagnosis. The goal of this article is to review up-to-date imaging techniques, normal sonographic anatomy, and characteristic sonographic features of common and uncommon disorders affecting the gastrointestinal tract in children.

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Sonographic diagnosis of appendicitis: A pictorial essay and a new diagnostic maneuver

Kadasne¹,

Sabih²,

Puri³

et al. 2021

J of Clinical Ultrasound

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While many cases of appendicitis are easy to diagnose clinically, a significant number need further workup in the form of imaging. Ultrasound and CT are both used extensively to diagnose or exclude appendicitis, or arrive at an alternate diagnosis. Ultrasound has many advantages but can be a difficult modality to use due to, among other reasons, the anatomical variations in appendicial location. The true retrocolic appendix is particularly difficult to diagnose with ultrasound. This pictorial essay examines the ultrasound features of normal and diseased appendix and proposes a new examining station, the prone view, for visualizing true retrocolic appendicitis.

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The non-diagnostic ultrasound in appendicitis: is a non-visualized appendix the same as a negative study?

Cited by 66 publications

References 23 publications

Secondary signs may improve the diagnostic accuracy of equivocal ultrasounds for suspected appendicitis in children

Secondary signs may improve the diagnostic accuracy of equivocal ultrasounds for suspected appendicitis in children

Abdominal ultrasonography of the pediatric gastrointestinal tract

Sonographic diagnosis of appendicitis: A pictorial essay and a new diagnostic maneuver

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