ARRS 2022 Abstracts

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E1600. Pediatric Appendicitis: Sonographic Pearls, Pitfalls, and Pathologic Correlation for the Trainee on Call
Authors
  1. Michael Hood; Wake Forest School of Medicine
  2. Marthe Munden; Medical University of South Carolina; Wake Forest School of Medicine
  3. George Koberlein; Wake Forest School of Medicine
Background
In children, acute appendicitis is one of the most frequent causes of abdominal pain as well as one of the most common surgical emergencies. Timely and accurate diagnosis is critical to reduce the risk of perforation or other complications. Current ACR guidelines recommend ultrasound as the initial modality to image suspected acute appendicitis in the pediatric population because of its proven safety and lack of ionizing radiation. Ultrasound is reliably accurate in this context, but even in the hands of experienced operators, multiple pitfalls may confound the diagnosis.

Educational Goals / Teaching Points
In this exhibit, essential criteria and helpful secondary signs of appendicitis at ultrasound are reviewed. Common causes of mistaken diagnoses are explored with tips to avoid them, including false-positives (misidentified artifact, Meckel diverticulum) and false-negatives (retrocecal position, perforation). Such disease entities include not only mimics of appendicitis (mesenteric adenitis, infectious/inflammatory bowel disease, intussusception, functional ovarian cyst, tubo-ovarian abscess, and adnexal torsion), but also less common variants of appendicitis (such as due to mobile cecum, midgut malrotation, or Amyand hernia).

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Key points of this exhibit include ediatric appendix and anatomic variants, right lower quadrant pain, other sources of right lower quadrant pain, and ultrasound.

Conclusion
This exhibit will review the practical keys to accurate sonographic diagnosis of appendicitis and illustrate common imaging pitfalls encountered in a busy pediatric practice. Examples cited are reinforced by clearly annotated image selections with gross surgical-pathologic correlation.