Imaging of Acute Appendicitis in Children: Ultrasonography

Part of the Medical Radiology book series (MEDRAD)


This chapter describes the normal and abnormal findings in ultrasound when imaging the appendiceal region in a child. Next to practical tips in imaging the appendix, potential pitfalls in diagnosing appendicitis are highlighted. The criteria for diagnosing appendicitis are summarized and clear guidelines are pointed out to handle equivocal cases. A wide range of illustrations make this chapter a very practical approach to imaging appendicitis in childhood.


Cystic Fibrosis Acute Appendicitis Secondary Sign Normal Appendix Inflame Appendix 
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  1. Baldisserotto M, Maffazzoni DR, Dora MD (2005) Omental infarction in children: Color Doppler sonography correlated with surgery and pathology findings. Am J Roentgenol 184:156–162Google Scholar
  2. Cobben LP, van Otterloo AM, Puylaert JBCM (2000) Spontaneously resolving appendicitis: Frequency and natural history in 60 patients. Radiology 215:349–352PubMedGoogle Scholar
  3. Holscher HC, Heij HA (2009) Imaging of acute appendicitis in children EU versus U.S. …or US versus CT? a European perspective. Pediatr Radiol 39:497–499PubMedCrossRefGoogle Scholar
  4. Jeffrey RB, Laing FC, Townsend RR (1988) Acute appendicitis: Sonographic criteria based on 250 cases. Radiology 167:327–329PubMedGoogle Scholar
  5. Jona JZ, Belin RP (1976) Basilar pneumonia simulating acute appendicitis in children. Arch Surg 111:552–553PubMedGoogle Scholar
  6. Kimmey MB, Martin RW, Haggit RC, Wang KY, Franklin DW, Silverstein FE (1989) Histological correlates of gastrointestinal ultrasound images. Gastroenterology 96:433–441PubMedGoogle Scholar
  7. Lardenoye SW, Puylaert JBCM, Smit MJ, Holscher HC (2004) Appendix in children with cystic fibrosis: US features. Radiology 232:187–189PubMedCrossRefGoogle Scholar
  8. Lee JH, Jeong YK, Hwang JC, Ham SY, Yang SO (2001) Graded compression sonography with adjuvant use of a posterior manual compression technique in the sonographic diagnosis of acute appendicitis. Am J Roentgenol 178:863–868Google Scholar
  9. Lee JH, Jeong YK, Park KB, Park JK, Jeong AK, Hwnag JC (2005) Operator-dependent techniques for graded compression sonography to detect the appendix and the diagnose acute appendicitis. Am J Roentgenol 184:91–97Google Scholar
  10. Puylaert JBCM (1986) Acute appendicitis: US evaluation using graded compression. Radiology 158:355–360PubMedGoogle Scholar
  11. Puylaert JBCM, Rutgers PH, Lalisang RI (1987) A prospective study of ultrasonography in the diagnosis of appendicitis. N Engl J Med 317:666–669PubMedCrossRefGoogle Scholar
  12. Quillin SP, Siegel MJ (1995) Diagnosis of appendiceal abscess in children with acute appendicitis: Value of color Doppler sonography. Am J Roentgenol 164:1251–1254Google Scholar
  13. Schuh S, Man C, Cheng A, Murphy A, Mohanta A, Moineddin R, Tomlinson G, Langer JC, Doria AS (2010) Predictors of non-diagnostic ultrasound scanning in children with suspected appendicitis. J Pediatr 158:123–129Google Scholar
  14. Simonovský V (2002) Normal appendix: is there any significant difference in the maximal mural thickness at US between pediatric and adult populations? Radiology 224:333–337PubMedCrossRefGoogle Scholar
  15. Strouse PJ (2010) Pediatric appendicitis: an argument for US. Radiology 255:8–13PubMedCrossRefGoogle Scholar
  16. Uncu N, Bülbül M, Yildiz N, Noyan A, Koşan C, Kavukçu S, Calişkan S, Gündüz Z, Beşbaş N, Gür Güven A (2010) Primary peritonitis in children with nephrotic syndrome: Results of a 5 year multicenter study. Eur J Pediatr 169:73–76PubMedCrossRefGoogle Scholar
  17. van Breda Vriesman AC, Puylaert JBCM (1999) Old and new infarction of an epiploic appendage: Ultrasound mimicry of appendicitis. Abdom Imaging 24:129–131PubMedCrossRefGoogle Scholar
  18. van Breda Vriesman AC, Puylaert JBCM (2002) Epiploic appendagitis and omental infarction: Pitfalls and look-alikes. Abdom Imaging 27:20–28PubMedCrossRefGoogle Scholar
  19. van Breda Vriesman AC, Puylaert JBCM (2006) Mimics of appendicitis: Alternative nonsurgical diagnoses with sonography and CT. Am J Roentgenol 186:1103–1112CrossRefGoogle Scholar
  20. Vertuno LL, Dan JR, Wood W (1980) Segmental infarction of the omentum: a cause of the semi-acute abdomen. Am J Gastroenterol 74:443–446PubMedGoogle Scholar
  21. Wiersma F, Šrámek A, Holscher HC (2005) Ultrasonographic features of the normal appendix and surrounding area in children. Radiology 235:1018–1022PubMedCrossRefGoogle Scholar
  22. Wiersma F, Toorenvliet BR, Ruige M, Holscher HC (2008) Increased echogenicity of renal cortex: a transient feature in acutely ill children. Am J Roentgenol 190:240–243CrossRefGoogle Scholar
  23. Wiersma F, Toorenvliet BR, Bloem JL, Allema JH, Holscher HC (2009) US examination of the appendix in children with suspected appendicitis: the additional value of secondary signs. Eur Radiol 19:455–461PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.HAGA Teaching Hospital, Juliana Children’s HospitalDen HaagThe Netherlands

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