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Appendicitis in Young Children: Imaging Experience and Clinical Outcomes

Diana P. Rodriguez1, Sigella Vargas1, Michael J. Callahan1, David Zurakowski2 and George A. Taylor1

1 Department of Radiology, Children's Hospital Boston and Harvard Medical School, 300 Longwood Ave., Boston, MA 02115.
2 Department of Orthopaedic Surgery, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115.


Figure 1
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  		Fig. 1 —4-month-old boy with 3-day history of irritability and fever. Axial CT image with oral and IV contrast of right lower quadrant shows abnormally enhancing enlarged appendix (black arrows) with periappendiceal fat stranding (white arrow) consistent with acute appendicitis. Previously performed sonographic study suggested possible intussusception, followed by negative air enema.

 

Figure 2
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  		Fig. 2 —Theoretic curve showing inverse relationship between predicted perforation of appendix and patient's age. Logistic regression indicated following equation for curve: Probability of perforation = 1 / {1 + [exp (-0.90 + 0.18 x age)]}, where exp is the base of the natural logarithm (approximately 2.71). The strength of this nonlinear relationship is indicated by the large test statistic from the model (likelihood ratio test = 63.2; p < 0.0001).

 

Figure 3
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  		Fig. 3 —4-year-old girl with history of abdominal pain and distention. Axial CT image of right lower quadrant after administration of oral and IV contrast material shows soft-tissue density in retrocecal region (arrows) interpreted as possible nondistended appendix, suggestive of appendicitis. At surgery, this finding proved to be mesenteric adenitis and there was noninflamed appendix.

 

Figure 4
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  		Fig. 4A —6-year-old girl with history of abdominal pain. Prospectively, appendix was not identified, and study was interpreted as indeterminate. In retrospect, there is thickening of cecum (arrows). Appendicitis was confirmed at surgery. Axial CT image of right lower quadrant after administration of rectal contrast material.

 

Figure 5
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  		Fig. 4B —6-year-old girl with history of abdominal pain. Prospectively, appendix was not identified, and study was interpreted as indeterminate. In retrospect, there is thickening of cecum (arrows). Appendicitis was confirmed at surgery. Left lateral decubitus CT image of right lower quadrant.

 

Figure 6
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  		Fig. 5 —Axial CT image with rectal and IV contrast material in 9-year-old boy. Oblong-shaped structure in right lower quadrant (arrows) is suggestive of enlarged appendix. However, lack of cecal contrast material and delayed IV contrast limited evaluation, and study was considered indeterminate. Appendicitis was confirmed at surgery.

 

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