Ultrasound carries high sensitivity in diagnosing acute appendicitis in pediatric patients and is increasingly being used as the preferred method of diagnosis since it does not use ionizing radiation. Although an enlarged diameter of the appendix and non-compressibility are the primary indicators of appendicitis, they do not have perfect specificity. Therefore, secondary features of appendicitis are crucial in supporting the diagnosis of appendicitis. The most sensitive secondary finding of appendicitis is inflammatory echogenic periappendiceal fat. Other secondary signs of appendicitis are either infrequently present, like wall hyperemia, or entirely nonspecific, like periappendiceal free fluid. Improving diagnostic accuracy of appendicitis with additional secondary supportive signs would be helpful. We have subjectively observed that appendix shape may be a helpful secondary sign of appendicitis, and that in certain cases it forms a C-shape or curved appearance when inflamed. It mimics the appearance of the letter ‘C’ and hence, we termed it, the “C sign.” Retrospective review of 999 ultrasound appendix studies that were conducted in our hospital from January 1, 2022, to March 31, 2022, with 150 sonographically positive acute appendicitis cases, we found 10 patients with the positive C sign and deemed positive by US and pathologically to be acute appendicitis. It seems by observation that this sign is not sensitive but specific when found, for acute appendicitis. One probable explanation for this configuration is loop separation that occurs when the proximal and distal ends of the appendix are separated either by inflamed fat or wall thickening. Herein, we show a few examples of the appendiceal “C-sign”, describe our observations, and suggest its potential use as an additional secondary sign of appendicitis. Read More

Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023

Authors: Singh Jasmeet, Milks Kathryn

Keywords: Appendicitis, Ultrasound, C sign

Peripheral nerve pathology in the pediatric population can result in significant long-term morbidity and functional disability. The incidence of upper extremity nerve palsy after supracondylar fracture is 12-20% and less common in both bone forearm fractures in children. The majority of these palsies resolve without intervention. Standard of care for non-penetrating nerve injury is intervention when symptoms fail to improve by 3 months. Preoperative imaging guides surgical management. For example, nerve entrapments can be released; however, nerve grafts may be required for high grade injuries including neuroma-in-continuity or transection. MR neurography is challenging for median, ulnar, and radial nerves. Small nerve size necessitates long scan duration sometimes requiring sedation. Ultrasound is emerging as an excellent modality for problem-solving in persistent post-traumatic palsies because of its high resolution, dynamic imaging which can be performed quickly and without sedation. We describe applications of ultrasound in localization of nerve injuries and sonographic characteristics of various peripheral nerve pathology. Read More

Meeting name: SPR 2022 Annual Meeting & Postgraduate Course , 2022

Authors: Pelissier Lindsey, Milks Kathryn

Keywords: non-penetrating