Abdominal pain and inconclusive ultrasound: a CT scan may not always be the best next step
A 4-year-old male presented to the emergency department with fever, mucous diarrhea, abdominal pain, and vomiting for 36 hours. On abdominal palpation, he had generalized pain without rebound and increased hydroaereal sounds. The blood count showed leukocytosis and elevated C-reactive protein, and a...
| Autores principales: | , , , |
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| Formato: | Artículo revista |
| Lenguaje: | Español |
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Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2025
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| Materias: | |
| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/44691 |
| Aporte de: |
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I10-R327-article-44691 |
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Universidad Nacional de Córdoba |
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I-10 |
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R-327 |
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Revista de la Facultad de Ciencias Médicas de Córdoba |
| language |
Español |
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Artículo revista |
| topic |
appendicitis abdominal pain radiography abdominal pediatrics general surgery apendicitis dolor abdominal radiografía abdominal pediatría cirugía general apendicite Dor Abdominal radiografia abdominal pediatria cirurgia geral |
| spellingShingle |
appendicitis abdominal pain radiography abdominal pediatrics general surgery apendicitis dolor abdominal radiografía abdominal pediatría cirugía general apendicite Dor Abdominal radiografia abdominal pediatria cirurgia geral Moreno -Alfonso, Julio César Hernández Martín, Sara Ayuso González, Lidia Perez Martínez, Alberto Perez Martínez, Alberto Perez Martínez, Alberto Abdominal pain and inconclusive ultrasound: a CT scan may not always be the best next step |
| topic_facet |
appendicitis abdominal pain radiography abdominal pediatrics general surgery apendicitis dolor abdominal radiografía abdominal pediatría cirugía general apendicite Dor Abdominal radiografia abdominal pediatria cirurgia geral |
| author |
Moreno -Alfonso, Julio César Hernández Martín, Sara Ayuso González, Lidia Perez Martínez, Alberto Perez Martínez, Alberto Perez Martínez, Alberto |
| author_facet |
Moreno -Alfonso, Julio César Hernández Martín, Sara Ayuso González, Lidia Perez Martínez, Alberto Perez Martínez, Alberto Perez Martínez, Alberto |
| author_sort |
Moreno -Alfonso, Julio César |
| title |
Abdominal pain and inconclusive ultrasound: a CT scan may not always be the best next step |
| title_short |
Abdominal pain and inconclusive ultrasound: a CT scan may not always be the best next step |
| title_full |
Abdominal pain and inconclusive ultrasound: a CT scan may not always be the best next step |
| title_fullStr |
Abdominal pain and inconclusive ultrasound: a CT scan may not always be the best next step |
| title_full_unstemmed |
Abdominal pain and inconclusive ultrasound: a CT scan may not always be the best next step |
| title_sort |
abdominal pain and inconclusive ultrasound: a ct scan may not always be the best next step |
| description |
A 4-year-old male presented to the emergency department with fever, mucous diarrhea, abdominal pain, and vomiting for 36 hours. On abdominal palpation, he had generalized pain without rebound and increased hydroaereal sounds. The blood count showed leukocytosis and elevated C-reactive protein, and an ultrasound revealed intestinal loops with abundant content, increased peristalsis, and a normal appendix. Due to the suspicion of invasive gastroenteritis, he was admitted for observation. Due to the persistence of symptoms, a new ultrasound was performed which showed pelvic free fluid but did not identify the appendix. An abdominal radiography was previously performed, which showed an image compatible with appendicolith. With the suspicion of appendicitis, surgery was indicated, and an appendicular peritonitis was identified. The patient recovered well and was discharged seven days later. Diagnosing appendicitis in children can be a complex process. The most sensitive diagnostic tests are ultrasound and tomography. Abdominal radiography, however, is a widely available test with low radiation and has a positive predictive value of 90% for appendicitis (detecting appendicolith or periappendicular 'air silence'). In ambiguous cases, an abdominal X-ray could avoid invasive tests that require sedation or high doses of radiation. |
| publisher |
Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología |
| publishDate |
2025 |
| url |
https://revistas.unc.edu.ar/index.php/med/article/view/44691 |
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I10-R327-article-446912025-04-14T15:15:05Z Abdominal pain and inconclusive ultrasound: a CT scan may not always be the best next step Dolor abdominal y ecografía no concluyente: no siempre lo siguiente es la tomografía Dor abdominal e ecografia inconclusiva: a TAC nem sempre é a melhor opção Moreno -Alfonso, Julio César Hernández Martín, Sara Ayuso González, Lidia Perez Martínez, Alberto Perez Martínez, Alberto Perez Martínez, Alberto appendicitis abdominal pain radiography abdominal pediatrics general surgery apendicitis dolor abdominal radiografía abdominal pediatría cirugía general apendicite Dor Abdominal radiografia abdominal pediatria cirurgia geral A 4-year-old male presented to the emergency department with fever, mucous diarrhea, abdominal pain, and vomiting for 36 hours. On abdominal palpation, he had generalized pain without rebound and increased hydroaereal sounds. The blood count showed leukocytosis and elevated C-reactive protein, and an ultrasound revealed intestinal loops with abundant content, increased peristalsis, and a normal appendix. Due to the suspicion of invasive gastroenteritis, he was admitted for observation. Due to the persistence of symptoms, a new ultrasound was performed which showed pelvic free fluid but did not identify the appendix. An abdominal radiography was previously performed, which showed an image compatible with appendicolith. With the suspicion of appendicitis, surgery was indicated, and an appendicular peritonitis was identified. The patient recovered well and was discharged seven days later. Diagnosing appendicitis in children can be a complex process. The most sensitive diagnostic tests are ultrasound and tomography. Abdominal radiography, however, is a widely available test with low radiation and has a positive predictive value of 90% for appendicitis (detecting appendicolith or periappendicular 'air silence'). In ambiguous cases, an abdominal X-ray could avoid invasive tests that require sedation or high doses of radiation. Un varón de 4 años acudió a urgencias por un cuadro de 36 horas de fiebre, diarrea mucosa, dolor abdominal y vómito. Presentaba dolor generalizado a la palpación abdominal profunda, sin defensa y ruidos hidroaéreos aumentados. La analítica mostró leucocitosis y elevación de PCR y una ecografía visualizó asas intestinales con abundante contenido, peristaltismo aumentado y un apéndice normal. Con la sospecha de gastroenteritis invasiva fue ingresado en observación. Ante persistencia de la sintomatología se realizó nueva ecografía evidenciando líquido libre pélvico sin identificar el apéndice, por lo que se planteó realizar tomografía, no obstante, previamente se optó por una radiografía abdominal observando una imagen compatible con apendicolito. Con la sospecha de apendicitis se indicó la cirugía, identificando una peritonitis apendicular. El paciente evolucionó favorablemente siendo dado de alta siete días después. Establecer el diagnóstico de apendicitis puede ser complejo en niños. Los estudios más sensibles son la ecografía y tomografía. La radiografía abdominal, por su parte, es una prueba ampliamente disponible, de baja radiación y con hallazgos con un valor predictivo positivo del 90% en la apendicitis (apendicolito, “silencio aéreo” periapendicular). En cuadros ambiguos, una radiografía abdominal podría evitar pruebas invasivas que precisan sedación o altas dosis de radiación. Um rapaz de 4 anos deu entrada no serviço de urgência com 36 horas de febre, diarreia mucosa, dor abdominal e vómitos. Apresentava dor generalizada à palpação abdominal profunda, sem defesa e com ruídos hidroaéreos aumentados. As análises laboratoriais revelaram leucocitose e PCR elevada e uma ecografia mostrou alças intestinais com conteúdo abundante, peristaltismo aumentado e um apêndice normal. Por suspeita de gastroenterite invasiva, foi internado para observação. Dada a persistência dos sintomas, foi realizada nova ecografia, que mostrou líquido pélvico livre, sem identificação do apêndice, pelo que se ponderou a realização de TC, apesar de ter sido realizada previamente uma radiografia abdominal, que mostrou imagem compatível com apendicólito. Com a suspeita de apendicite, foi indicada cirurgia, tendo sido identificada peritonite apendicular. O paciente evoluiu favoravelmente e recebeu alta sete dias depois. O estabelecimento do diagnóstico de apendicite pode ser complexo em crianças. Os exames mais sensíveis são a ultrassonografia e a tomografia. A radiografia abdominal, por outro lado, é um exame amplamente disponível, de baixa radiação, com um valor preditivo positivo de 90% na apendicite (apendicólito, "silêncio aéreo" periappendicular). Em casos ambíguos, a radiografia abdominal pode evitar exames invasivos que exijam sedação ou doses elevadas de radiação. Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2025-03-31 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf text/html https://revistas.unc.edu.ar/index.php/med/article/view/44691 10.31053/1853.0605.v82.n1.44691 Revista de la Facultad de Ciencias Médicas de Córdoba.; Vol. 82 No. 1 (2025); 206-214 Revista de la Facultad de Ciencias Médicas de Córdoba; Vol. 82 Núm. 1 (2025); 206-214 Revista da Faculdade de Ciências Médicas de Córdoba; v. 82 n. 1 (2025); 206-214 1853-0605 0014-6722 10.31053/1853.0605.v82.n1 spa https://revistas.unc.edu.ar/index.php/med/article/view/44691/48677 https://revistas.unc.edu.ar/index.php/med/article/view/44691/48781 Derechos de autor 2025 Universidad Nacional de Córdoba https://creativecommons.org/licenses/by-nc/4.0 |