Journal of Current Surgery, ISSN 1927-1298 print, 1927-1301 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Curr Surg and Elmer Press Inc
Journal website https://www.currentsurgery.org

Original Article

Volume 10, Number 3, September 2020, pages 21-27

A Retrospective Comparison Study of Ultrasonography and Computed Tomography Scan in Diagnosis of Acute Appendicitis in the Pediatric Population

Figures

Figure 1.
Figure 1. Incidence of ML decreases significantly after the first decade of life (P = 0.012). ML: mesenteric lymphadenitis.
Figure 2.
Figure 2. Vomiting is a likely symptom of acute appendicitis without the presentation of constipation or diarrhea (P = 0.0001). Subjective assessment for nausea as a symptom of acute appendicitis was insignificant (P = 0.056).
Figure 3.
Figure 3. Patients diagnosed with acute appendicitis were more likely to have elevated segmented neutrophils than leukocytosis on complete blood cell (P = 0.006). WNL: within normal limit.
Figure 4.
Figure 4. Insignificant findings in study population (P = 0.615 and 0.165 at home and in the hospital, respectively).
Figure 5.
Figure 5. Abdominal US displaying a normal diameter (< 6 mm) in a 9-year-old child with suspected appendicitis. Red arrow indicates appendix. US: ultrasonography
Figure 6.
Figure 6. Coronal CT imaging of the same child suggesting ruptured appendicitis (red arrow) with extensive peritonitis in the pelvis and free fluid in the pelvis (blue arrow). CT: computed tomography.
Figure 7.
Figure 7. Transverse abdominal section of CT imaging consistent with ruptured appendicitis (red arrow) and significant pelvic fluid accumulation (blue arrow) previously missed on abdominal US. CT: computed tomography; US: ultrasonography.

Tables

Table 1. Demographics and Radiologic Distributions
 
CT/US (+) is indicative of positive appendicitis per radiology report. CT/US (-/equivocal) is indicative of negative appendicitis, appendix not visible, or unclear on radiology report. SD: standard deviation; CT: computed tomography; US: ultrasound.
Patients (n)431
Age at operation, years (mean ± SD)12.29 ± 3.87
Gender (male/female)259/172
CT/US cohorts192/239
  CT (+)169
  CT (-/equivocal)23
  US (+)122
  US (-/equivocal)117

 

Table 2. Radiologic Accuracy in Conjunction With Pathology Report and Incidence of ML
 
*Low number of subjects calculated for specificity which may not be congruent with available literature [5, 9]. PPV: positive predictive value; ML: mesenteric lymphadenitis; CT: computed tomography; US: ultrasonography.
CT/US cohorts
  CT sensitivity/specificity (%)*91.16%/63.63%
  CT PPV (%)97.63%
  US sensitivity/specificity (%)*52.86%/83.33%
  US PPV (%)98.36%
Positive pathology (n, %)
  CT182 (94.8%)
  US227 (94.9%)
ML (n, %)109 (25.8%)