Paracolic lymph nodes: A novel diagnostic sign for pediatric perforated appendicitis?

Abstract

Objective: Acute appendicitis is the most common reason for emergency abdominal surgery in pediatric population. Ultrasonography (US) is a widely used modality to diagnose acute appendicitis. Despite its success in diagnosing acute appendicitis, US have been reported to have a poor diagnostic accuracy to detect perforated appendicitis. We have frequently encountered lymph nodes around transvers colon in pediatric perforated appendicitis cases. We mainly aim to evaluate the accuracy of paracolic lymph node presence as a new diagnostic marker for perforated appendicitis. Materials and Methods: We have evaluated the US reports and/or images of the patients referred to radiology department with a clinical suspicion of acute appendicitis. Paracolic lymph node presence and sonographic findings indicating perforated appendicitis were recorded. Patients were divided into three subgroups according to their final diagnosis: Acute appendicitis, perforated appendicitis, others. Results: Mean age of the population was 14.9±2.3 years. There were 300 acute appendicitis cases, 71 perforated appendicitis cases, and 92 other diagnosis cases (4 lymphoid hyperplasia, 88 normal appendix). Rates of lymph node presence in paracolic area were 41/300 (13.6%) in acute appendicitis subgroup, 58/71 (81.6%) in perforated appendicitis subgroup, and 4/92 (4.34%) in other diagnosis subgroup. A longest diameter of a paracolic lymph node > 8.5 mm seemed to be a good predictor for perforated appendicitis diagnosis (sensitivity 85%, specificity 77%). Conclusion: we showed a statistically significant association between paracolic lymph node presence and perforated appendicitis. This sign can serve to confirm perforated appendicitis diagnosis over simple appendicitis.

Keywords

• Perforated appendicitis,children,ultrasound,lymph node,paracolic

Parakolik lenf nodu: Pediyatrik perfore apandisitte yeni bir tanı belirteci olabilir mi?

Abstract

Amaç: Çalışmada perikolonik lenf nodu varlığının perfore apandisit için yeni bir tanı işareti olarak kullanılıp kullanılamayacağını değerlendirmek amaçlandı. Gereç ve Yöntem: Bu retrospektif çalışmaya akut apandisit şüphesi ile pediatrik radyoloji bölümüne sevk edilen toplam 463 hasta dahil edildi. Perfore apandisit ile ilişkili perikolonik lenf nodu varlığı ve sonografik bulgular kaydedildi. Hastalar kesin tanılarına göre üç alt gruba ayrıldı: akut apandisit, perfore apandisit ve diğerleri. Bulgular: 300 akut apandisit vakası, 71 perfore apandisit vakası ve “diğer tanı” grubunda 92 hasta vardı. Her grupta perikolonik lenf nodu varlığı sıklığı şu şekilde idi: Akut apandisit alt grubunda 41/300 (% 13,6), delikli apandisit alt grubunda 58/71 (% 81,6) ve diğer tanıda 4/92 (% 4,34) hasta bulunmakta idi. Perfore apandisit tanısı için en az 8,5 mm çapında bir perikolonik lenf nodu varlığı iyi bir yordayıcı olarak belirlendi (duyarlılık% 85, özgüllük% 77). Sonuç: Perikolonik lenf nodu varlığı ile perfore apandisit arasında istatistiksel olarak anlamlı bir ilişki olduğunu gösterdik. Bu işaret, perfore apandisit olduğundan şüphelenilen vakalarda tanıyı doğrulamaya yardımcı olabilir.

Keywords

• Perfore apandisit,çocuk,ultrason,lenf nodu,parakolik

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