Dirk Schaper, V. Hofmann (Halle/S.)  

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12 Years  

Female  

GI-Other and unknown  

inflammatory or infectious  

12 year-old girl, stomach ache in the right lower quadrant. No vomiting, normal gait, no abdominal guarding. Slight pain on pressure in the right lower quadrant. Leucocytes: 11000, CRP <8  

N/A  

<- view Ultrasound 1

Ultrasound 1: little corcade in the right lower quadrant, surroudned somewhat by free fluid, not collapsable, layered construction well-preserved.




<- view Ultrasound 2

Ultrasound 2: Tubular structure in the right lower quadrant, some free fluid, no Peristalsis, not compressible, well-maintained walls.




<- view Ultrasound 3

Ultrasound 3: Doppler, Obvious increase in circulation in cross-section.

 

Surgery / Histo  

N/A  

Because of the obvious presentation of the appendix, as well as the patient's history with stomach ache and pain on pressure in the right lower quadrant, the patient underwent surgery, which confirmed our diagnosis.  

The sonographic difference of all childred with stomach aches is an important part of the diagnostic tests in our clinic. Besides ruling out other painful illnesses, the sonographic examination of the appendix is taking on a more important role. Particularly in cases with unclear presenting symptoms and unsymptomatic laboratory values, sonography is very helpful. In many cases, it allows the presentation of the appendix, the measurement of it, and the rating of the circulation. With color doppler sonography, one can localize the inflammatory process very well. In some particular cases, the atypically located appendix could be localized by its typical sonographic findings (subhepatic appendix, appendicitis in an inverse situs with ceceal raising). A high level of experience is needed to present the appendix and to be able to assess it. The increasingly better ultrasound machines allows this to be assessed with more success.  

N/A  

1. Medline:
Hormann M, Scharitzer M, Stadler A, Pokieser P, Puig S, Helbich T.
Ultrasound of the appendix in children: is the child too obese?
Eur Radiol 2003 Jun;13(6):1428-31

2. Medline:
Even-Bendahan G, Lazar I, Erez I, Guttermacher M, Verner M, Konen O, Rathaus V, Freud E.
Role of imaging in the diagnosis of acute appendicitis in children.
Clin Pediatr (Phila) 2003 Jan-Feb;42(1):23-7

3. Medline:
Bendeck SE, Nino-Murcia M, Berry GJ, Jeffrey RB Jr.
Imaging for suspected appendicitis: negative appendectomy and perforation rates.
Radiology 2002 Oct;225(1):131-6  

appendicitis, acute appendicitis, appendix, appendix vermiformis, appendectomy, leukocytosis, abdominal pain, child, childhood, pediatric radiology  

Dirk Schaper, V Hofmann. Acute appendicitis. PedRad [serial online] vol 3, no. 6.
URL: www.PedRad.info/?search=20030605124844