ABSTRACT
STUDY OBJECTIVE: To determine the accuracy of diagnosing appendicitis in the pediatric population by using graded compression ultrasonography. DESIGN: Retrospective case review. SETTING: University-affiliated community hospital with an emergency department census of approximately 19,000 pediatric visits per year. TYPE OF PARTICIPANTS: Ninety-eight children (age less than 13 years) with clinically suspected appendicitis who had graded compression sonographic studies during the 24-month study period. INTERVENTIONS: Medical records were reviewed for patient demographics, presenting signs and symptoms, sonographic findings, surgical results, and hospital course. Patients who did not undergo surgery were followed up by telephone for a minimum of two months. RESULTS: Ninety-eight children (42 boys and 56 girls; age range, 2 to 12 years; mean age, 8.0 years) with clinical signs and symptoms of acute appendicitis were examined sonographically. Of the 26 patients whose appendicitis was verified at surgery, ultrasound was positive in 22, with an overall sensitivity of 85%. Of the 72 patients who did not have appendicitis, ultrasound was negative in 68, with a specificity of 94%. Two patients with false-positive ultrasound went to surgery and were found to have acute ileitis and perforated Meckel's diverticulum. The overall diagnostic accuracy was 91.8% (90 of 98). CONCLUSION: Use of ultrasound to diagnose acute appendicitis was performed with a sensitivity of 85% and a specificity of 94%. This allows the same accuracy in children as has been reported with adults.
Subject(s)
Appendicitis/diagnostic imaging , Acute Disease , Appendix/diagnostic imaging , Child , Child, Preschool , Evaluation Studies as Topic , False Positive Reactions , Female , Humans , Male , Retrospective Studies , Sensitivity and Specificity , UltrasonographyABSTRACT
A prospective study was performed to evaluate the diagnostic methods used in acute maxillofacial trauma. Clinical examination, routine facial x-rays with linear tomography, and computer tomography were compared in 49 patients. Computer tomography was found to be the most accurate test in the diagnosis of facial bone injury, especially complex fractures. Computer tomography also provided valuable information regarding soft-tissue injury of the face. The radiation doses of linear tomography and computer tomography were calculated to be below the level known to cause cataract formation. Computer tomography is a safe, reliable adjunct in the diagnosis of acute maxillofacial trauma and should be strongly considered after initial screening measures are completed.
Subject(s)
Maxillofacial Injuries/diagnosis , Adolescent , Adult , Aged , Child , Female , Humans , Male , Maxillary Fractures/diagnostic imaging , Maxillary Fractures/surgery , Maxillofacial Injuries/diagnostic imaging , Maxillofacial Injuries/surgery , Middle Aged , Nasal Bone/injuries , Orbital Fractures/diagnostic imaging , Orbital Fractures/surgery , Physical Examination , Prospective Studies , Skull Fractures/diagnostic imaging , Skull Fractures/surgery , Surgery, Plastic , Tomography, X-Ray , Tomography, X-Ray ComputedABSTRACT
Two patients with Wilms tumor are presented. One patient had a bilateral Wilms tumor with invasion of the right renal pelvis and proximal ureter. A second patient presented with a large Wilms tumor originating separate from and inferior to the left kidney. The histologic, therapeutic, and prognostic implications of these radiographic presentations are explored.
