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Evaluation of Suspected Appendicitis in Children Using Limited Helical CT and Colonic Contrast Material

¹ Department of Radiology, Founders House, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St., Boston, MA 02114.
² Department of Pediatric Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114.
³ Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114.

View larger version (148K): [in a new window]   Fig. 1. —9-year-old girl with acute appendicitis (true-positive). CT scan obtained with colonic contrast material and 5-mm collimation through lower abdomen and pelvis shows markedly enlarged, nonfilling appendix (between straight arrows). Note appendicolith (curved arrow). Fat-stranding is diffuse. Note also arrowhead sign of thickened cecal wall pointing to appendiceal orifice. All findings are consistent with appendicitis. At surgery, patient was found to have acute appendicitis.

View larger version (129K): [in a new window]   Fig. 2. —18-year-old girl with distal appendicitis (false-negative). CT scan obtained with colonic contrast material and 5-mm collimation through lower abdomen and pelvis shows tubular structure that was identified as likely appendix in right lower quadrant. Proximal portion was noted to fill with contrast material (arrow). Findings were initially interpreted as negative for appendicitis. However, at surgery patient was found to have acute distal appendicitis (inflammation of distal portion, or tip, with normal proximal appendix).

View larger version (106K): [in a new window]   Fig. 3. —8-year-old girl with abdominal pain (true-negative). CT scan obtained with colonic contrast material and 5-mm collimation through lower abdomen and pelvis shows nonenlarged filling appendix (arrow) without appendicolith. Mesenteric fat does not show fat stranding. Patient was discharged with diagnosis of abdominal pain, not otherwise specified, and did well.

View larger version (112K): [in a new window]   Fig. 4. —17-year-old girl with abdominal pain (false-positive). CT scan obtained with colonic contrast material and 5-mm collimation through lower abdomen and pelvis shows curved tubular structure adjacent to cecum (arrow) that was identified as likely appendix and that did not fill with contrast material. Findings were initially interpreted as positive for appendicitis, but patient had normal appendix at surgery.

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