HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: 2242010998v1 224/2/325    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Callahan, M. J. Articles by Taylor, G. A. Search for Related Content PubMed PubMed Citation Articles by Callahan, M. J. Articles by Taylor, G. A.

CT of Appendicitis in Children¹

¹ From the Department of Radiology, Children’s Hospital, 300 Longwood Ave, Boston, MA 02115. Received June 5, 2001; revision requested June 27; revision received September 10; accepted October 16. Address correspondence to G.A.T. (e-mail: george.taylor@tch.harvard.edu).

Appendicitis is the most common condition requiring intraabdominal surgery in infancy and childhood. Yet, despite its common occurrence, accurate diagnosis remains challenging. Acute appendicitis may be missed at initial clinical examination in 28%–57% of children aged 12 years and younger and in nearly 100% of children under the age of 2 years. Diagnostic imaging has an ever-increasing role in the prompt and accurate diagnosis of acute appendicitis in the pediatric population. At the authors’ institution, helical computed tomography (CT) is the primary tool for diagnosing or excluding appendicitis in children. Since its inception in 1998, helical CT with rectally administered contrast material has been shown to reduce the total number of inpatient observation days, laparotomies with negative findings, and per-patient cost. Helical CT is a highly sensitive and specific tool for diagnosing pediatric appendicitis and has resulted in a beneficial change in patient care in 68.5% of all patients seen in the authors’ emergency department for suspected appendicitis. This includes both those patients who receive an eventual diagnosis of appendicitis and those who do not have the disease. Major strengths of limited helical CT with rectal contrast material include producing uniformly high published sensitivity and specificity values for diagnosis of appendicitis and enabling diagnosis of alternative conditions of acute abdominal pain in children. In contrast, limitations of graded-compression ultrasonography in children include highly operator-dependent sensitivity and specificity values and relative infrequency with which the normal appendix can be visualized in this population. Although there have been many exciting diagnostic advancements for the diagnosis of acute appendicitis in the pediatric population, the role of helical CT is far from clear. The purpose of this article is to describe a helical CT approach to imaging in children suspected of having acute appendicitis at a large urban pediatric teaching hospital and its effects on patient outcomes and hospital costs.

© RSNA, 2002

Index terms: Appendix, CT, 751.12112, 751.12119 • Computed tomography (CT), in infants and children • Radiology and radiologists, How I Do It

This article has been cited by other articles:

				M. Baldisserotto, S. G. Valduga, and C. F. J. S. da Cunha MR Imaging Evaluation of the Normal Appendix in Children and Adolescents Radiology, October 1, 2008; 249(1): 278 - 284. [Abstract] [Full Text] [PDF]

				M. J. Goske, K. E. Applegate, J. Boylan, P. F. Butler, M. J. Callahan, B. D. Coley, S. Farley, D. P. Frush, M. Hernanz-Schulman, D. Jaramillo, et al. The Image Gently Campaign: Working Together to Change Practice Am. J. Roentgenol., February 1, 2008; 190(2): 273 - 274. [Full Text] [PDF]

				M. Tsuboi, K. Takase, I. Kaneda, T. Ishibashi, T. Yamada, M. Kitami, S. Higano, and S. Takahashi Perforated and Nonperforated Appendicitis: Defect in Enhancing Appendiceal Wall Depiction with Multi Detector Row CT Radiology, January 1, 2008; 246(1): 142 - 147. [Abstract] [Full Text] [PDF]

				J. H. Thrall Commentary on "Are We Really Practicing Medicine Today?" Radiology, November 1, 2007; 245(2): 331 - 332. [Full Text] [PDF]

				A. B. Kharbanda, G. A. Taylor, and R. G. Bachur Suspected Appendicitis in Children: Rectal and Intravenous Contrast-enhanced versus Intravenous Contrast-enhanced CT Radiology, May 1, 2007; 243(2): 520 - 526. [Abstract] [Full Text] [PDF]

				D. P. Rodriguez, S. Vargas, M. J. Callahan, D. Zurakowski, and G. A. Taylor Appendicitis in young children: imaging experience and clinical outcomes. Am. J. Roentgenol., April 1, 2006; 186(4): 1158 - 1164. [Abstract] [Full Text] [PDF]

				T. Sung, M. J. Callahan, and G. A. Taylor Clinical and Imaging Mimickers of Acute Appendicitis in the Pediatric Population Am. J. Roentgenol., January 1, 2006; 186(1): 67 - 74. [Abstract] [Full Text] [PDF]

				N. Pinto Leite, J. M. Pereira, R. Cunha, P. Pinto, and C. Sirlin CT Evaluation of Appendicitis and Its Complications: Imaging Techniques and Key Diagnostic Findings Am. J. Roentgenol., August 1, 2005; 185(2): 406 - 417. [Abstract] [Full Text] [PDF]

				G. A. Taylor Suspected Appendicitis in Children: In Search of the Single Best Diagnostic Test Radiology, May 1, 2004; 231(2): 293 - 295. [Full Text] [PDF]

				S. Kaiser, T. Finnbogason, H. K. Jorulf, E. Soderman, and B. Frenckner Suspected Appendicitis in Children: Diagnosis with Contrast-enhanced versus Nonenhanced Helical CT Radiology, May 1, 2004; 231(2): 427 - 433. [Abstract] [Full Text] [PDF]

				D. P. Frush, L. F. Donnelly, and N. S. Rosen Computed Tomography and Radiation Risks: What Pediatric Health Care Providers Should Know Pediatrics, October 1, 2003; 112(4): 951 - 957. [Abstract] [Full Text] [PDF]