CT OF APPENDICITIS IN CHILDREN

Purpose: Our goal was to review the CT findings and to help define the role of CT in the evaluation of appendicitis in children. Method: Of 730 children with surgically proven appendicitis, 22 underwent pre-ope rative CT evaluation. Their CT scans and operative and pathology recor ds were retrospectively reviewed. The CT scans were evaluated for appe ndiceal wall thickness, diameter, and location, appendicoliths, perice cal inflammation, phlegmon, abscess, free fluid, small bowel dilatatio n, and bowel wall thickening. Criteria for diagnosing appendicitis wer e (a) appendiceal wall thickening (>1 mm) or (b) presence of abscess, phlegmon, or pericecal inflammation associated with appendicolith(s). Prospective reports of ultrasound examinations performed within 2 days of the CT scans were available in 14 children and were correlated wit h the CT findings. Results: An abnormally thickened appendix, with a d iameter ranging from 9 to 18 mm, was seen in four children. Three appe ndices were retrocecal and one was near the cecal tip, anterior to the iliac vessels. Appendicoliths were present in 10 children, multiple i n 1. Abscesses were seen in 13 of 22 children, multiple in 5. Phlegmon was seen in five children and pericecal inflammation in two. Bowel wa ll thickening was present in seven children and small bowel dilatation was noted in six. Other findings included free fluid, hydronephrosis, thickening of urinary bladder wall, air in the uterus and vagina, ade nopathy, and thickening of the abdominal wall musculature. CT was diag nostic of appendicitis in 11 of 22 children (50%). In 14 children with both ultrasound and CT studies, CT was slightly better in diagnosing appendicitis and visualizing the abnormal appendix and was superior in defining the presence and extent of abscess and inflammation in 9 of 14 children. Conclusion: CT is a useful adjunct in diagnosing appendic itis in children, with a major role in cases of complicated appendicit is.