CT scans often are used to detect appendicitis, but a new study at the Children's Hospital at Montefiore Medical Center in New York suggests that ultrasound is equally adept at diagnosing this emergency condition. That’s important, because a CT image is an X-ray, which emits radiation; an ultrasound image, which involves sound waves, does not.
The research was published in the American Journal of Roentgenology, and concluded that not only is ultrasound safer than a CT scan and provides a comparable result, it does not increase the length of a hospital stay, another important consideration in medical treatment.
As reported on ScienceDaily.com, appendicitis is one of the most commonly experienced conditions among children in the U.S., and it’s becoming more frequent. Usually, a CT scan is the imaging technique used to evaluate patients with symptoms of appendicitis.
That’s inflammation of the appendix, a small pouch attached to the beginning of the large intestine. Appendicitis is the result of a blockage by a foreign object (food morsel, fingernail, etc.) feces or, rarely, a tumor, and the site becomes infected.
The study was a collaboration between radiologists and clinicians in pediatric surgery and emergency medicine. They increased the use of ultrasound as the first imaging option from 1 in 3 at the beginning of the study to almost 9 in 10 at the study's completion. Use of a CT scan as the first and only diagnostic test decreased from about 4 in 10 to fewer than 1 in 10 by the end of the study.
In a news release from Montefiore, co-author Jessica Kurian, M.D., said, "As more people become aware of the risks of medical radiation, there are increasing efforts to utilize nonradiation emitting imaging techniques as a first approach to diagnosis. Our research shows that using ultrasound first in the evaluation of appendicitis commonly produces actionable results and should be considered more frequently as clinicians try to limit medical radiation exposure in children."
As we explained in “More Evidence to Let Caution Be Your Guide in CT Scans,” radiation is cumulative, and the more you receive over the course of your life, the likelier you are to develop cancer. (See our backgrounder on radiation overdose injuries.) Sometimes, diagnosis via X-ray is necessary, but if there are options, such as ultrasound or MRI, they should be exercised. If your doctor suspects appendicitis is the cause of your child’s problem, and plans to perform a CT scan, ask instead for an ultrasound.
Symptoms of appendicitis can vary, and it can be difficult to diagnose in young children. Usually, the first symptom is pain that might be mild at first, but becomes sharper and more severe. Appetite falls off, and often there is nausea, vomiting and a low fever.
If the appendix ruptures, the pain might diminish briefly, but once the lining of the abdominal cavity becomes swollen and infected (a condition known as peritonitis), the pain escalates. Serious, later symptoms include:
Treatment is surgical removal of the appendix. If it’s removed before it ruptures, recovery is generally quick. If the appendix has ruptured, recovery is slower are more likely to involve complications such as infection.