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

Yıl 2020, Cilt: 14 Sayı: 4, 366 - 370, 26.06.2020

Çiğdem Üner İbrahim Karaman

https://doi.org/10.12956/tchd.733279

Öz

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.

Anahtar Kelimeler

Perforated appendicitis, children, ultrasound, lymph node, paracolic

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

Öz

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.

Anahtar Kelimeler

Perfore apandisit, çocuk, ultrason, lenf nodu, parakolik

Kaynakça

• 1. Carpenter JL, Orth RC, Zhang W, Lopez ME, Mangona KL, Guillerman RP. Diagnostic Performance of US for Differentiating Perforated from Nonperforated Pediatric Appendicitis: A Prospective Cohort Study. Radiology. 2017;282(3):835-41. 2. Sivit CJ. Imaging the child with right lower quadrant pain and suspected appendicitis: current concepts. Pediatric radiology. 2004;34(6):447-53. 3. Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. American journal of epidemiology. 1990;132(5):910-25. 4. Tulin-Silver S, Babb J, Pinkney L, Strubel N, Lala S, Milla SS, et al. The challenging ultrasound diagnosis of perforated appendicitis in children: constellations of sonographic findings improve specificity. Pediatric radiology. 2015;45(6):820-30. 5. Linam LE, Munden M. Sonography as the first line of evaluation in children with suspected acute appendicitis. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. 2012;31(8):1153-7. 6. Aydin S, Tek C, Ergun E, Kazci O, Kosar PN. Acute Appendicitis or Lymphoid Hyperplasia: How to Distinguish More Safely? Can Assoc Radiol J. 2019;70(4):354-60. 7. Leeuwenburgh MM, Wiezer MJ, Wiarda BM, Bouma WH, Phoa SS, Stockmann HB, et al. Accuracy of MRI compared with ultrasound imaging and selective use of CT to discriminate simple from perforated appendicitis. The British journal of surgery. 2014;101(1):e147-55. 8. Tseng P, Berdahl C, Kearl YL, Behar S, Cooper J, Dollbaum R, et al. Does Right Lower Quadrant Abdominal Ultrasound Accurately Identify Perforation in Pediatric Acute Appendicitis? The Journal of emergency medicine. 2016;50(4):638-42. 9. Narsule CK, Kahle EJ, Kim DS, Anderson AC, Luks FI. Effect of delay in presentation on rate of perforation in children with appendicitis. The American journal of emergency medicine. 2011;29(8):890-3. 10. Lee SL, Stark R, Yaghoubian A, Shekherdimian S, Kaji A. Does age affect the outcomes and management of pediatric appendicitis? Journal of pediatric surgery. 2011;46(12):2342-5. 11. Gonzalez DO, Lawrence AE, Cooper JN, Sola R, Jr., Garvey E, Weber BC, et al. Can ultrasound reliably identify complicated appendicitis in children? The Journal of surgical research. 2018;229:76-81. 12. Blumfield E, Nayak G, Srinivasan R, Muranaka MT, Blitman NM, Blumfield A, et al. Ultrasound for differentiation between perforated and nonperforated appendicitis in pediatric patients. AJR American journal of roentgenology. 2013;200(5):957-62. 13. Azzali G. Three-dimensional and ultrastructural aspects of the lymphatic vascularization of the vermiform appendix. Journal of submicroscopic cytology and pathology. 1998;30(4):545-53. 14. Broker ME, van Lieshout EM, van der Elst M, Stassen LP, Schepers T. Discriminating between simple and perforated appendicitis. The Journal of surgical research. 2012;176(1):79-83.