What is the role of chest radiography in the workup of pediatric appendicitis?

Updated: Oct 25, 2018
  • Author: Adam C Alder, MD; Chief Editor: Carmen Cuffari, MD  more...
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If the history, physical examination, laboratory tests, and imaging studies have failed to produce a satisfactory differential diagnosis, anteroposterior (AP) and lateral chest radiography should be performed to look for right lower lobe pneumonia.

Typically, histologic findings range from acute inflammatory infiltrate most apparent in the submucosal level in early appendicitis to transmural infarction in perforated appendicitis.

The finding of an apparently normal appendix at surgery requires careful follow-up of the histologic findings. Occasionally, early appendicitis is histologically identified and clinically correlates with the resolution of preoperative symptoms. Additionally, unsuspected findings of luminal nematodes should indicate further anthelmintic therapy (eg, mebendazole [Vermox]). Chronic inflammation or fibrosis of the tip of the appendix are occasionally seen and coincide with resolution of the symptoms.

Many surgeons now encounter patients with “early appendicitis” based on history, physical examination findings, and/or CT scans who had minimal changes found in the appendix in the operating room or only intraluminal inflammatory cells on histology. Most of these patients have complete resolution of their signs and symptoms after appendectomy. Whether this is because the appendectomy is performed at an earlier stage of appendicitis or is due to the placebo effect of the appendectomy is unknown.

For more information, see the Medscape Reference article Appendicitis Imaging.

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