Tristan Reddan

Ultrasound of paediatric appendicitis and its secondary sonographic signs: providing a more meaningful finding

Sonography is an important clinical tool in diagnosing appendicitis in children as it can obviate both exposure to potentially harmful ionising radiation from computed tomography scans and the need for unnecessary appendicectomies. This review examines the diagnostic accuracy of ultrasound in the identification of acute appendicitis, with a particular focus on the the utility of secondary sonographic signs as an adjunct or corollary to traditionally examined criteria. These secondary signs can be important in cases where the appendix cannot be identified with ultrasound and a more meaningful finding may be made by incorporating the presence or absence of secondary sonographic signs. There is evidence that integrating these secondary signs into the final ultrasound diagnosis can improve the utility of ultrasound in cases where appendicitis is expected, though there remains some conjecture about whether they play a more important role in negative or positive prediction in the absence of an identifiable appendix.

Improving the value of ultrasound in children with suspected appendicitis: a prospective study integrating secondary sonographic signs

Purpose The purpose of this study was to determine whether the awareness and inclusion of secondary sonographic signs of appendicitis, in combination with a structured evaluation as part of engagement and training for sonographers, improved appendix visualization rates and reduced equivocal findings in children with suspected acute appendicitis. Methods This was a prospective study of 230 children at a tertiary children’s hospital in Australia referred for an ultrasound examination of suspected appendicitis. The ultrasound findings, radiology reports, histology, clinical results, and follow-up were collated. Secondary signs were used as an additional assessment of the likelihood of disease where possible, even in the absence of an identified appendix. Results The implementation of a structured evaluation as part of sonographer engagement and training resulted in a 28% improvement in appendix visualization (68.7%) compared with a prior retrospective study in a similar population (40.7%). The diagnostic accuracy was 91.7%, with likelihood ratios suggesting a meaningful influence of the pre-test probability of appendicitis in children studied (positive likelihood ratio, 11.22; negative likelihood ratio, 0.09.). Only 7.8% of the findings were equivocal. A binary 6-mm diameter cut-off did not account for equivocal cases, particularly lymphoid hyperplasia. Conclusion Engagement of sonographers performing pediatric appendiceal ultrasound through training in the scanning technique and awareness of secondary signs significantly improved the visualization rate and provided more meaningful findings to referrers.

Sonographic diagnosis of acute appendicitis in children: a 3-year retrospective

Ultrasound is commonly used as a tool for investigation of acute appendicitis in children. The accuracy of ultrasound in appendicitis depends on the ability to visualise the appendix and the potential contribution from secondary signs. The study was a retrospective analysis of children referred for sonographic investigation of possible acute appendicitis at an Australian tertiary paediatric hospital between January 2008 and December 2010.

Analysis of the predictive value of clinical and sonographic variables in children with suspected acute appendicitis using decision tree algorithms: Decision tree analysis paediatric appendicitis

We evaluated the predictive value of sonographic and clinical variables in the diagnosis of acute appendicitis in children using decision tree modelling.

An audit of referral time frames for ultrasound screening of developmental hip dysplasia in neonates with a normal antenatal clinical examination: Developmental dysplasia of the hip audit

Ultrasound has an established role in the detection of developmental dysplasia of the hip (DDH). Lack of uniformity in the appropriate age to perform studies in at‐risk children with a normal clinical examination at birth exists. Opening a new tertiary paediatric hospital saw a variety of referral time frames for initial screening ultrasound for DDH.

Not just a bump on the head: ultrasound as first-line imaging in a boy with Pott's puffy tumour

While computed tomography (CT) and magnetic resonance imaging (MRI) have established roles in evaluating Potts puffy tumour, ultrasound can play a valuable role in identifying the condition, particularly in children. We present the case of a boy with a fluctuant forehead lump and headaches, where ultrasound was the first‐line imaging modality and expedited further investigations.

Ultrasound of a prepubertal Leydig cell tumour of the testis

Leydig cell tumours of the testis are uncommon. They typically present in a bimodal age distribution between either 5 and 10 years of age, or 20 to 60 years of age. Affected prepubertal boys usually present with a palpable lump or precocious puberty. With improvements in imaging technology, diagnosis can be incidental and precede clinical symptoms. This report describes the incidental finding of a Leydig cell tumour of the testis in an eight-year-old boy with a history of scrotal trauma and haematuria.

Stumped? It could be stump appendicitis

Inflammation of an appendiceal remnant, or stump, after appendicectomy is a little-known clinical presentation. Sonography can be useful in the diagnosis of stump appendicitis; by either directly visualising the inflamed stump, or by identifying secondary sonographic signs that can raise suspicion of the condition. It is important that sonographers are aware of this possible diagnosis in patients that have previously undergone appendicectomy. We describe two cases of children presenting with right lower quadrant pain post-appendicectomy.