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    原作者: Mimi Lu,肖鋒譯 發布日期:2013-05-20

    Title: Pediatric ultrasound and appendicitis
    Author 作者: Mimi Lu

    An overweight 5 year old male presents with acute onset abdominal pain that localizes to the right lower quadrant. What are some causes of a limited or nondiagnostic ultrasound study in children?
    Acute appendicitis is a time sensitive diagnosis. Ultrasound is frequently used as the initial diagnostic imaging in children. There are several reasons why the appendix may not be visualized, including retro-cecal location, normal appendix, perforation, and inflammation around the distal tip. An additional clinical predictor associated with poor or inconclusive ultrasound results in appendicitis is increased BMI (body mass index).
    A study examining 263 pediatric patients found when BMI > 85th percentile and clinical probability of appendicitis was <50%, 58% of ultrasounds were nondiagnostic. Children with a BMI <85th percentile and clinical probability of appendicitis was <50%, had nondiagonstic scans 42% of the time. These trends were also mimicked in the patients with a higher clinical probability of appendicitis. In the child with a nondiagnostic ultrasound, options include observation and repeat ultrasound scan or CT scan, both of which have associated risks.
    包括263小兒患者的一項研究發現,當BMI>85百分位和闌尾炎臨床可能性<50%時,58%的超聲波不能明確診斷。 BMI<85百分位和闌尾炎臨床可能性<50%的兒童,有42%的超聲檢查不能明確診斷。在臨床闌尾炎可能性很高的患者中也有類式的趨勢。對于超聲不能明確診斷的孩子,可選擇觀察和重復超聲波檢查或CT掃描,當然這兩者都有一定的風險。
    Reference 參考文獻:
    Schuh S, et al. Predictors of non-diagnostic ultrasound scanning in children with suspected appendicitis. J Pediatr. 2011 Jan;158(1):112-8.