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Appendicitis in a Child with an Abscess

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0:01

So MRI can have limitations,

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which are important to keep in mind.

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They are very sensitive to motion.

0:06

You may need occasional anesthesia or

0:10

some sort of sedation if the child is

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young enough and can't stay still for it.

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MRI is limited in evaluating for free air.

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So just things to keep in mind.

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But it is often still quite diagnostic

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and maybe better than a CT scan.

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So in this case, another child,

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you can follow that colon down.

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In this case, it's a bit harder to identify

0:32

the appendix versus the terminal ileum.

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You do have this.

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It's a thick-walled structure that has

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what looks like bowel signature that

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does appear to attach here to the cecum.

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I find it hard in this particular case to

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tell exactly where the terminal ileum is to

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prove that this is the appendix, but we do

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have these T2 dark structures within this

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loop of bowel here that could be air, you

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know, or they certainly could be appendicoliths.

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The structure, however, when you

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follow it, it does look blind-ending.

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It just stops here in the right lower quadrant.

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You see some T2 bright free fluid here,

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and then what's more importantly here, you

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didn't just diagnose acute appendicitis,

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but you're looking for the complications.

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So here we have an example of an abscess

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from an acute appendicitis on MRI.

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So this is the bladder anteriorly, it's being

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squished by this volume of fluid right here.

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This is not just free fluid, it's

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pushing on the structures nearby.

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This is an abscess.

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It is thick-walled.

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It has an air-fluid level right here.

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Here's a little bit of air.

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That's rising on the pus,

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basically sitting back here.

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It's a little bit heterogeneous because

1:35

remember it is purulent material.

1:38

And then you have a little bit of,

1:40

sorry, rectum back here behind it.

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Thick-walled back here as well.

1:44

And that's reactive in this case because

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there's a large abscess sitting upon it.

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So in these cases, you do not need contrast.

1:51

This is a relatively quick exam.

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It's just several coronal and

1:54

axial T2-weighted imaging.

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No contrast is necessary for these.

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And you can diagnose acute appendicitis and

2:00

an abscess, both in the same examination,

2:04

relatively quick for these kids.

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So they don't have to be under

2:06

anesthesia very long if they need it.

2:08

And if they're older and don't need

2:09

it, they can tolerate the exam quite

2:11

well, given that it's relatively short.

Report

Faculty

Kathryn McGillen, MD

Assistant Professor of Radiology, Medical Director of Ultrasound

Penn State University Milton S Hershey Medical Center

Tags

MRI

Infectious

Gastrointestinal (GI)

Body

Appendix

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