Sonography Essay

1291 WordsAug 12, 20126 Pages
Acute appendicitis is the most common cause of abdominal pain requiring urgent surgery in children and is a true gastrointestinal emergency.1 The diagnosis is suspected and made primarily on the basis of clinical findings. Classically, these clinical findings consist of periumbilical pain migrating to the right lower quadrant, accompanied by fever and leukocytosis. However, the classic signs are not always present, and symptoms can be nonspecific and overlap with other causes of abdominal pain. The clinical presentation is also complicated in young children by their limited communication skills. Historically, computed tomography (CT) has been the first choice of imaging in acute abdominal pain, with sensitivity of up to 96% and specificity of up to 97%.2–5 However, because of the increasing awareness of the radiation dose imparted to patients by CT and the theoretical increased risk of cancer that it causes,6 there is a nationwide campaign to reduce the radiation from diagnostic imaging in children (Image Gently).7 Sonography uses sound waves instead of ionizing radiation to evaluate for disease and in some studies has demonstrated accuracy similar to that of CT.5,8 Therefore, sonography should be used as the primary diagnostic modality in the evaluation of suspected acute appendicitis in children. Sonography is widely available, can be performed at the bedside, involves a short acquisition time, does not use ionizing radiation, is relatively inexpensive, and may show evidence of other causes of abdominal pain. It is particularly useful in evaluating young women, in whom the radiation dose to the reproductive organs should be minimized and for whom it is important to exclude ovarian and uterine conditions that might mimic appendicitis. There have been multiple studies evaluating the value of sonography in the evaluation of appendicitis, showing varying

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