The diagnosis of pediatric appendicitis can be difficult, with a substantial proportion misdiagnosed based on clinical features and laboratory tests alone. Accordingly, advanced imaging with ultrasound (US), computed tomography (CT), and/or magnetic resonance imaging has become routine for most children undergoing diagnostic evaluation for appendicitis. There is increasing interest in the use of US as the primary imaging modality and reserving CT as a secondary diagnostic modality in equivocal cases. Magnetic resonance imaging, using a rapid protocol, without contrast or sedation, has been found to be highly sensitive and specific in the evaluation of children with acute right lower quadrant pain in a number of studies. Because magnetic resonance imaging has the advantage over CT of not using contrast or ionizing radiation, it may replace CT in many instances, whether after US as part of a stepwise imaging algorithm or as a primary imaging modality. Accessibility and cost, however, limit its more widespread use currently.
Attending Physician, Pediatric Emergency Medicine, Children's Hospital of Philadelphia; Associate Professor of Clinical Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
The author, faculty, and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interest in, any commercial organizations relevant to this educational activity.
Reprints: Manoj K. Mittal, MD, ML, MRCP (UK), FAAP, FACEP, Division of Emergency Medicine, Children's Hospital of Philadelphia, 3501 Civic Center Blvd, Philadelphia, PA 19104 (e-mail: Mittal@email.chop.edu).