Identification of Pediatric Retrocecal Appendicitis Using Point of Care Ultrasound (POCUS).

Abstract

Acute appendicitis is the most common pediatric surgical emergency. Diagnosis may be made by targeted point of care ultrasound (POCUS) of the right lower quadrant (RLQ) abdomen. This can be performed by trained emergency physicians and has similar accuracy to ultrasound performed by radiology technologists and interpreted by radiologists (RADUS) [1,2]. Pediatric patients with appendicitis may present without classical clinical signs and symptoms. Retrocecal appendicitis is often diagnosed late at perforation due to the anatomical position limiting diagnosis with ultrasound, despite the high prevalence of retrocecal appendix as an anatomic variation (up to 65%). Given the limited sensitivity for ultrasound in the diagnosis of appendicitis in patients with retrocecal appendix, these patients often undergo advanced imaging with computed tomography (CT) or magnetic resonance imaging (MRI), especially when increased abdominal wall thickness and/or high Body Mass Index (BMI) further limit the ultrasound examination [4-6]. We present a case series of retrocecal appendicitis imaged and diagnosed with POCUS, using novel transducer and patient positioning. In addition to standard graded compression of the RLQ with POCUS, this technique may add to the diagnostic accuracy of patients presenting atypically with anatomic variants.