US Features of the Normal Appendix and Surrounding Area in Children

Abstract

To evaluate prospectively the frequency of depiction with ultrasonography (US) of the appendix in children without clinical suspicion of acute appendicitis and to evaluate the US appearance of the normal appendix. Between March 2003 and July 2003, 146 consecutive patients (62 boys and 84 girls; mean age, 7 years; age range, 2-15 years) without clinical suspicion of acute appendicitis were examined with US. Patients with cystic fibrosis and those with acute abdominal pain were excluded from the study. Outer diameters, mural thickness, and color Doppler flow were measured. Appendiceal lumen and surroundings of the appendix were determined. The overall diameter and mural thickness of the appendix were examined for relationship to age, weight, or height of the patient. For statistical analysis, the Mann-Whitney test, Student t test, and linear regression analysis were applied. In 120 (82%) children, the appendix was depicted with US; in 26 (18%) children, this was not possible. In 114 (95%) of the depicted appendices, the position was classical; we observed six (5%) retrocecal appendices. All appendices were compressible. Mean diameter of the appendix was 0.39 cm (range, 0.21-0.64 cm), and the mean mural thickness was 0.18 cm (range, 0.11-0.27 cm). The appendiceal lumen was empty in 74 (62%) children. The others were filled with fecal material, gas, or both. In 75 (51%) of the 146 children, lymph nodes were present in the right lower quadrant of the abdomen. We found no relation between the age, weight, or height of the examined child and the overall diameter or wall of the appendix. The results of this study show that a normal appendix can be depicted with US in 82% of asymptomatic children.