Sonographic diagnosis of acute appendicitis in children

The authors performed graded compression abdominal ultrasound (US) examinations in children with suspected acute appendicitis, whose clinical presentation was atypical. Abdominal US examination results were 95% accurate, far exceeding that reported for other imaging modalities. The sensitivity was 86%, the specificity was 98%, and the positive and negative predictive values were 96% and 94%, respectively. A positive sonogram made the likelihood of acute appendicitis 50 times greater compared with the pretest clinical impression. In addition, the use of US permitted identification of other pathological conditions that manifest similar symptoms and signs. The authors conclude that, with proper experience, US can be extremely useful in assisting the surgeon to markedly decrease the number of unnecessary appendectomy procedures, without increasing the risk of perforation.