Imaging of Acute Appendicitis in Children: Radiography

  • Daniel N. VinocurEmail author
  • Edward Y. Lee
Part of the Medical Radiology book series (MEDRAD)


Acute appendicitis is the most common cause for emergent abdominal surgery in pediatric patients. Although most children with acute appendicitis typically present with clinical signs and symptoms that suggest acute appendicitis, approximately one-third of children with acute appendicitis have uncertain and non-specific clinical signs and symptoms. In these pediatric patients, further evaluation with imaging studies is often necessary for proper patient management. The overarching goal of this chapter is to review the plain radiographic evaluation of acute appendicitis in children including current imaging technique, characteristic primary and secondary imaging findings, and interpretation of plain radiographs of acute appendicitis in pediatric population.


Acute Appendicitis Plain Radiograph Small Bowel Obstruction Perforated Appendicitis Diagnostic Quality Image 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Cobb LM, Lelli JL (1993) Appendicitis. In: Reisdorf EJ, Roberts MR, Wiegenstein JG (eds) Pediatric emergency medicine. WB Saunders, Philadelphia, PA 314–321Google Scholar
  2. Godderidge C (1995) Pediatric Imaging. Saunders Company, Philadelphia, PAGoogle Scholar
  3. Hatten LE, Miller RC, Hester CL Jr, Moynihan PC (1973) Appendicitis and the abdominal roentgenogram in children. South Med J 66:803–806PubMedCrossRefGoogle Scholar
  4. Isdale JM (1978) The radiological signs of acute appendicitis in infancy and childhood. S Afr Med J 53:363–364PubMedGoogle Scholar
  5. Johnson JF, Coughlin WF, Stark P (1988) The sensitivity of plain films for detecting perforation in children with appendicitis. Rofo 149:619–623PubMedCrossRefGoogle Scholar
  6. Kaneko K, Tsuda M (2004) Ultrasound-based decision making in the treatment of acute appendicitis in children. J Pediatr Surg 39:1316–1320PubMedCrossRefGoogle Scholar
  7. Kirks DR (1998) Practical pediatric imaging, diagnostic radiology of infants and children. Lippincott-Raven, Philadelphia, PAGoogle Scholar
  8. Kwok MY, Kim MK, Gorelick MH (2004) Evidence-based approach to the diagnosis of appendicitis in children. Pediatr Emerg Care 20:690–698 (quiz 699–701)Google Scholar
  9. Leonidas JC, Harris DJ, Amoury RA (1975) How accurate is the roentgen diagnosis of acute appendicitis in children. Ann Radiol (Paris) 18:479–487Google Scholar
  10. Puig S, Staudenherz A, Felder-Puig R, Paya K (2008) Imaging of appendicitis in children and adolescents: useful or useless? A comparison of imaging techniques and a critical review of the current literature. Semin Roentgenol 43:22–28PubMedCrossRefGoogle Scholar
  11. Riggs W Jr, Parvey LS (1976) Perforated appendix presenting with disproportionate jejunal distention. Pediatr Radiol 5:47–49PubMedCrossRefGoogle Scholar
  12. Rothrock SG, Pagane J (2000) Acute appendicitis in children: emergency department diagnosis and management. Ann Emerg Med 36:39–51PubMedCrossRefGoogle Scholar
  13. Shimkin PM (1978) Radiology of acute appendicitis. AJR Am J Roentgenol 130:1001–1004PubMedGoogle Scholar
  14. Sivit CJ (2004) Imaging the child with right lower quadrant pain and suspected appendicitis: current concepts. Pediatr Radiol 34:447–453PubMedCrossRefGoogle Scholar
  15. Sivit CJ, Applegate KE (2003) Imaging of acute appendicitis in children. Semin Ultrasound CT MR 24:74–82PubMedCrossRefGoogle Scholar
  16. Sivit CJ, Siegel MJ, Applegate KE, Newman KD (2001) When appendicitis is suspected in children. Radiographics 21:247–262 (questionnaire 288–294)Google Scholar
  17. Smink DS, Finkelstein JA, Garcia Pena BM, Shannon MW, Taylor GA, Fishman SJ (2004) Diagnosis of acute appendicitis in children using a clinical practice guideline. J Pediatr Surg 39:458–463 (discussion 458–463)Google Scholar
  18. Steinert R, Hareide I, Christiansen T (1943) Roentgenolic examination of acute appendicitis. Acta Radiol 24:13–27Google Scholar
  19. Swischuk LE, Hayden CK Jr (1980) Appendicitis with perforation: the dilated transverse colon sign. AJR Am J Roentgenol 135:687–689PubMedGoogle Scholar
  20. Vasavada P (2004) Ultrasound evaluation of acute abdominal emergencies in infants and children. Radiol Clin North Am 42:445–456PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of RadiologyChildren’s Hospital Boston and Harvard Medical SchoolBostonUSA

Personalised recommendations