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Acute appendicitis in children: ultrasound and CT findings in negative appendectomy cases

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Abstract

Background

To decrease the negative appendectomy rate in children, knowledge of the misleading imaging findings on US and CT in negative appendicitis cases is important.

Objective

To evaluate the negative appendectomy rate and describe the imaging findings of US and CT that lead radiologists to misdiagnose acute appendicitis in children.

Materials and methods

From 2007 to 2013, 374 children operated for suspected appendicitis were proved to either have acute appendicitis (n = 348) or to be negative for appendicitis (n = 26) on pathological reports. Negative appendectomy rates were compared among imaging modalities, age groups and genders. We retrospectively reviewed US and CT findings from negative appendectomy cases.

Results

The overall negative appendectomy rate was 7.0% (26/374). There were no statistically significant differences among the subgroups. The most common misleading presentations on US were sonographic tenderness (9/16, 56%) and non-compressibility (9/16, 56%). The most common misleading finding on CT were the presence of an appendicolith or hyperdense feces (5/12, 42%). Periappendiceal fat inflammation was observed in only one case of negative appendicitis on US and on CT.

Conclusion

Radiologists can misdiagnose children with equivocal diameters of appendices as having acute appendicitis when sonographic tenderness or non-compressibility is present on US and when an appendicolith or hyperdense feces is noted on CT. The possibility of negative appendicitis should be borne in mind when periappendiceal fat inflammation is absent or minimal in indeterminate cases.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea

    Seong Ho Kim, Young Hun Choi, Woo Sun Kim, Jung-Eun Cheon & In-One Kim

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  1. Seong Ho Kim
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  2. Young Hun Choi
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  3. Woo Sun Kim
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  4. Jung-Eun Cheon
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  5. In-One Kim
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Correspondence to Young Hun Choi.

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Kim, S.H., Choi, Y.H., Kim, W.S. et al. Acute appendicitis in children: ultrasound and CT findings in negative appendectomy cases. Pediatr Radiol 44, 1243–1251 (2014). https://doi.org/10.1007/s00247-014-3009-x

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  • DOI: https://doi.org/10.1007/s00247-014-3009-x

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