0:01

So, ultrasound in the pediatric population

0:03

can be limited either by body habitus

0:05

or patient ability to cooperate for the

0:07

exam, or simply given the many different

0:10

positions of a normal appendix

0:12

may not be visible via ultrasound.

0:14

So, again, with considerations of radiation

0:17

in the pediatric population, MRI is another

0:19

good modality to evaluate for appendicitis,

0:23

and for other etiologies of a patient

0:25

presenting with right lower quadrant pain.

0:27

In general, at our institution, we

0:29

mostly rely on T2-weighted imaging.

0:31

So this is a T2-weighted

0:32

imaging, non-fat-saturated.

0:36

This is the axial image, and you can

0:37

follow it down just like you do a CT scan.

0:39

Here's your colon right here.

0:40

Here's your terminal ileum coming off.

0:42

So a few slices down, we

0:43

should see the appendix.

0:46

And the appendix we see right here, it's going

0:47

to still be a tubular blind-ending structure,

0:50

oftentimes smaller than the terminal ileum.

0:52

But if the appendicitis is bad

0:54

enough, it may be similarly sized.

0:56

Here it is coming off right here.

0:57

You can follow it all the way

0:58

around and it's right here.

1:00

And the beauty of MRI as well is that

1:03

the T2 bright reactive free fluid

1:05

will show up very avidly on an MRI.

1:09

So you can see that there is an

1:10

inflammatory process going on down here.

1:13

You can also use your coronal images

1:14

which can be really helpful in this situation.

1:17

And so here we are with another

1:18

T2 non-fat-saturated image.

1:20

Here's your appendix.

1:22

Here's a little bit of free fluid

1:25

that is attaching to the cecum.

1:27

If you aren't sure that there's inflammation

1:29

in that area, or if you aren't sure that it's

1:30

centred around the appendix, you also have

1:32

your T2-weighted, fat-saturated imaging.

1:35

And so in this case, that T2 bright

1:37

fluid is going to stand out like

1:38

a light bulb, as it is right here.

1:40

It's also going to show you the

1:41

inflammation along the appendix itself.

1:44

You see how it's a little bit bright

1:45

around both sides of the appendix,

1:47

all the way up to its origin here?

1:49

Okay.

1:49

That's the inflammation that will show up

1:51

beautifully on a T2 fat-saturated image

1:54

and confirm that it's the appendix that's

1:56

abnormal, and not an adjacent right lower

1:58

quadrant structure that's the problem.

2:00

So this is diagnostic of

2:02

acute appendicitis in a child.

2:07

Again, one more view right here just to show

2:09

you all of that inflammation and free fluid.

2:11

Much harder to see the appendix itself, but

2:14

you can see the free fluid and the inflammation

2:17

that will help you diagnose acute appendicitis.