Cartagena Claudia,  Herliczek Thaddeus,  Dibble Elizabeth,  Swenson David

Final Pr. ID: Poster #: SCI-035

To describe the spectrum and incidence of alternative etiologies for lower abdominal and pelvic pain identified on magnetic resonance imaging (MRI) following indeterminate appendix ultrasound (US) in pediatric patients. Read More

Authors:  Cartagena Claudia , Herliczek Thaddeus , Dibble Elizabeth , Swenson David

Keywords:  abdominal, pelvic, appendix

Castro Denise,  Hopman Wilma,  Regan Rosemary,  Sauerbrei Eric,  Soboleski Don

Final Pr. ID: Poster #: SCI-023

Perception plays a significant role in the interpretation of images (Fig.1). A medical image perception society (MIPS) now exists with a goal to improve the understanding of imaging perceptual factors. Perception in sonography is different than other modalities where images are produced in a specifically formatted manner and then evaluated later by the observer (passive perception). Ultrasound is performed in a less standardized process to provide the best acoustic window of the region of concern. Image production requires the operator’s perceptual skills while acquiring the images (interactive perception). The study purpose was to determine if experience, knowledge base or scan time correlates with an imagers perceptual ability to visualize the normal appendix. Read More

Authors:  Castro Denise , Hopman Wilma , Regan Rosemary , Sauerbrei Eric , Soboleski Don

Keywords:  perception, appendix, sonography

Jaganathan Sriram,  Rowell Amy,  Ali Sumera,  Krishnan Venkatram,  Jayappa Sateesh,  Murphy Janice,  Ramakrishnaiah Raghu,  Wong Kevin,  Schmitz Kelli,  Choudhary Arabinda,  Buchmann Robert

Final Pr. ID: Poster #: EDU-032

Objectives:
Acute appendicitis is one of the common emergent indications for imaging in the hospital setting. Though ultrasound and/or CT remains the primary imaging modality, MRI with rapid sequence imaging is also gaining credence at multiple pediatric institutions to replace CT or even replacing Ultrasound in specific settings, as the first line imaging modality. Our aim in this exhibit is to present our initial experience on implementation of a limited rapid sequence MRI appendix, at our tertiary care pediatric hospital, to evaluate for acute RLQ pain. We also detail the advantages of MRI over CT scan, pitfalls of MRI, the appearance of acute appendicitis and complications including perforation/ abscess, and other pathologies, which we found on MRI during the evaluation for acute abdominal pain.
Learning points:
Our exhibit includes:
Role of MRI appendix – emerging as an alternative to CT in diagnostic dilemma and avoids radiation
Logistics of setting up MRI appendix protocol and managing expectations
Decision on when to use MRI for evaluation of suspected appendix
Describe rapid sequence tailored protocol developed at our institution
In the context of increasing supply chain disruption issues such as CT contrast shortage, the advantages and disadvantages of MRI
Normal appearance of the appendix and peri-appendiceal region
Classical appearances on MRI appendix
1. Acute Appendicitis
2. Inflammatory mass
3. Contained appendiceal perforation
4. Abscess
5. Identifying appendicolith
6. Perforated appendicitis with abscesses in extraperitoneal spaces
Alternate pathologies which we may mimic appendicitis and was identified on MRI
1. Terminal ileitis
2. Colitis
3. Ovarian pathology
Discussion:
Acute appendicitis is one of the common pathologies encountered in pediatric emergency setting and needs prompt attention. Ultrasound is the cheapest and most easily available imaging modality, but is operator dependent, and may be limited by patient body habitus, and location of the appendix. MRI is emerging as an alternative to CT in the evaluation of appendicitis in the pediatric population. Our initial experience with implementation of the MRI appendix protocol is promising in terms of acceptance by the clinical teams, image resolution, diagnostic confidence, logistical support from the administrators, sensitivity and patient outcome. We had the added benefit of being able to utilize this protocol during CT service disruptions and contrast shortage. Read More

Authors:  Jaganathan Sriram , Rowell Amy , Ali Sumera , Krishnan Venkatram , Jayappa Sateesh , Murphy Janice , Ramakrishnaiah Raghu , Wong Kevin , Schmitz Kelli , Choudhary Arabinda , Buchmann Robert

Keywords:  MRI Appendix, Rapid sequence imaging, iodinated contrast shortage

Essenmacher Alex,  Kao Simon,  Sato T Shawn

Final Pr. ID: Poster #: EDU-019

The management of acute appendicitis is most often surgical with appendectomy; the blind-ending, inflamed appendix is removed, usually laparoscopically. There is growing awareness of the potential for a delayed complication if only the tip or otherwise subtotal length is removed. A remnant portion of the base of the appendix, referred to as a stump, if long enough can become obstructed and symptomatic similar to the etiology of acute appendicitis. In cases of recurrent right lower quadrant pain in a patient with a surgical history of appendectomy, appendicitis remains on the differential diagnosis alongside non-appendiceal causes such a colitis and epiploic appendagitis. Imaging diagnosis by computed tomography or ultrasound of stump appendicitis is similar to acute appendicitis with right lower quadrant inflammation and stump distension and wall thickening. In this educational exhibit we will review the imaging features of stump appendicitis as well as developments in surgical techniques relevant to this delayed complication. Relevant anatomy and differential diagnosis for right lower quadrant pain will also be summarized. Read More

Authors:  Essenmacher Alex , Kao Simon , Sato T Shawn

Keywords:  appendix, surgery, appendicitis

Patel Falguni

Final Pr. ID: Poster #: CR-002 (T)

Purpose: To demonstrate Pediatric Acute Appendicitis with a secondary sign of an early perforation based on ultrasound findings. Read More

Authors:  Patel Falguni

Keywords:  Appendix, Right Lower Quadrant, Appedicolith