Abstract
Appendicitis is a common pediatric emergency and one of the most common causes for surgical exploration in the pediatric patient. Imaging has become an essential tool in the evaluation of the child with suspected appendicitis, aiming to avoid misdiagnosis and to facilitate early surgery, thus decreasing potential morbidity from ruptured appendicitis. The objective of this paper is to compare the luminal diameter of the normal appendix by computed tomography (CT) when utilizing the traditionally used high-attenuation oral contrast material (OCM), Gastrografin, and the relatively new neutral agent VoLumen, with the goal of establishing normal appendiceal size parameters for this neutral OCM. Twenty-six cases of VoLumen-enhanced CT studies of the abdomen and pelvis were identified, of which 13 met the inclusion criteria. These were randomly matched to age control Gastrografin CT examinations. Appendiceal diameters (from wall to wall) were measured in three orthogonal planes and the average of these was recorded. We show that there is no statistical difference between normal appendiceal diameters in patients with a VoLumen-opacified CT versus a Gastrografin-enhanced CT (p = 0.8) being 5.0 ± 1.3 and 5.1 ± 1.5 mm, respectively. Chart review revealed no clinical suspicion of appendicitis prior to imaging or on discharge diagnosis in the patients included in this study. The rate of nonvisualization of the appendix with VoLumen in our study was 31%, which equals previously published estimates in children. In summary, as VoLumen use increases in the evaluation of abdominal pathology in the ailing child, we provide guidelines to identify the normal appendix when utilizing this oral contrast agent.
Similar content being viewed by others
References
Rybkin AV, Thoeni RF (2007) Current concepts in imaging of appendicitis. Radiol Clin North Am 45:411–422
Wan MJ, Krahn M, Ungar WJ et al (2009) Acute appendicitis in young children: cost-effectiveness of US versus CT in diagnosis—a Markov decision analytic model. Radiology 250:378–386
Doria AS, Moineddin R, Kellenberger CJ et al (2006) US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology 241:83–94
Frush DP, Frush KS, Oldham KT (2009) Imaging of acute appendicitis in children: EU versus U.S.... or US versus CT? A North American perspective. Pediatr Radiol 39:500–505
Lane MJ, Katz DS, Ross BA et al (1997) Unenhanced helical CT for suspected acute appendicitis. AJR Am J Roentgenol 168:405–409
Rao PM, Rhea JT, Novelline RA et al (1997) Helical CT combined with contrast material administered only through the colon for imaging of suspected appendicitis. AJR Am J Roentgenol 169:1275–1280
Gulati K, Shah ZK, Sainani N et al (2008) Gastrointestinal tract labeling for MDCT of abdomen: comparison of low density barium and low density barium in combination with water. Eur Radiol 18:868–873
Hebert JJ, Taylor AJ, Winter TC et al (2006) Low-attenuation oral GI contrast agents in abdominal-pelvic computed tomography. Abdom Imaging 31:48–53
Mullins ME, Kircher MF, Ryan DP et al (2001) Evaluation of suspected appendicitis in children using limited helical CT and colonic contrast material. AJR Am J Roentgenol 176:37–41
Grayson DE, Wettlaufer JR, Dalrymple NC et al (2001) Appendiceal CT in pediatric patients: relationship of visualization to amount of peritoneal fat. AJR Am J Roentgenol 176:497–500
Kim PK, Zhu X, Houseknecht E et al (2005) Effective radiation dose from radiologic studies in pediatric trauma patients. World J Surg 29:1557–1562
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Victoria, T., Mahboubi, S. Normal appendiceal diameter in children: does choice of CT oral contrast (VoLumen versus Gastrografin) make a difference?. Emerg Radiol 17, 397–401 (2010). https://doi.org/10.1007/s10140-010-0873-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10140-010-0873-z