Title: Pediatric ultrasound and appendicitis
題目：兒科超聲檢查與闌尾炎
Author 作者: Mimi Lu

An overweight 5 year old male presents with acute onset abdominal pain that localizes to the right lower quadrant. What are some causes of a limited or nondiagnostic ultrasound study in children?
一個超體重的5歲男孩，以急性右下腹腹痛就診。造成超聲檢查在兒童中受限或不能確診的原因有哪些？
Acute appendicitis is a time sensitive diagnosis. Ultrasound is frequently used as the initial diagnostic imaging in children. There are several reasons why the appendix may not be visualized, including retro-cecal location, normal appendix, perforation, and inflammation around the distal tip. An additional clinical predictor associated with poor or inconclusive ultrasound results in appendicitis is increased BMI (body mass index).
急性闌尾炎是要快速診斷的。超聲在兒科病人中經常被用來作為初始診斷的影像檢查手段。有幾個原因可以來解釋為什么有時候會看不到闌尾，包括盲腸后的位置，正常闌尾，穿孔，和尖端周圍發炎。另外一個造成超聲檢查結果質量不高或不能確定闌尾炎的臨床預測指標是高BMI（體重指數）。
A study examining 263 pediatric patients found when BMI > 85th percentile and clinical probability of appendicitis was <50%, 58% of ultrasounds were nondiagnostic. Children with a BMI <85th percentile and clinical probability of appendicitis was <50%, had nondiagonstic scans 42% of the time. These trends were also mimicked in the patients with a higher clinical probability of appendicitis. In the child with a nondiagnostic ultrasound, options include observation and repeat ultrasound scan or CT scan, both of which have associated risks.
包括263小兒患者的一項研究發現，當BMI>85百分位和闌尾炎臨床可能性<50％時，58％的超聲波不能明確診斷。 BMI<85百分位和闌尾炎臨床可能性<50％的兒童，有42％的超聲檢查不能明確診斷。在臨床闌尾炎可能性很高的患者中也有類式的趨勢。對于超聲不能明確診斷的孩子，可選擇觀察和重復超聲波檢查或CT掃描，當然這兩者都有一定的風險。
Reference 參考文獻:
Schuh S, et al. Predictors of non-diagnostic ultrasound scanning in children with suspected appendicitis. J Pediatr. 2011 Jan;158(1):112-8.