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DOI: 10.1055/s-0030-1267979
© Georg Thieme Verlag KG Stuttgart · New York
Clinical Differentiation between Acute Appendicitis and Acute Mesenteric Lymphadenitis in Children
Publikationsverlauf
received August 17, 2010
accepted after revision October 09, 2010
Publikationsdatum:
14. Dezember 2010 (online)
![](https://www.thieme-connect.de/media/ejps/201102/lookinside/thumbnails/10.1055-s-0030-1267979-1.jpg)
Abstract
Introduction: Acute mesenteric lymphadenitis in children has a clinical presentation very similar to that of acute appendicitis. The aim of this study was to evaluate whether it is possible to clinically differentiate between acute appendicitis and acute mesenteric lymphadenitis in children.
Methods: A prospective cohort analysis was performed for all children (<17 years) presenting to the emergency department of our institution with acute abdominal pain between June 2005 and July 2006. The relevant clinical parameters, clinical and radiological diagnoses and all management decisions were scored prospectively. Ultrasound was the primary imaging modality for the majority of patients. All patients were re-evaluated until a final diagnosis was attained. The Alvarado score was calculated retrospectively, and a logistic regression model was used to analyze the diagnostic potential of clinical parameters.
Results: 289 patients were eligible for analysis. 38 patients had acute mesenteric lymphadenitis, and 69 patients had acute appendicitis as a final diagnosis. The positive predictive values of the clinical diagnosis, the Alvarado score and the logistic regression model were 0.62, 0.81 and 0.79 respectively. Ultrasound had a positive predictive value of 96% for acute appendicitis.
Conclusion: It is not possible to accurately distinguish acute mesenteric lymphadenitis from acute appendicitis in children using clinical evaluation alone. Ultrasound should be performed in equivocal cases.
Key words
appendicitis - mesenteric lymphadenitis - diagnosis
References
- 1 Puylaert JB. Mesenteric adenitis and acute terminal ileitis: US evaluation using graded compression. Radiology. 1986; 161 (3) 691-695
- 2 Rao PM, Rhea JT, Novelline RA. CT diagnosis of mesenteric adenitis. Radiology. 1997; 202 (1) 145-149
- 3 Gilmore OJ, Browett JP, Griffin PH. et al . Appendicitis and mimicking conditions. A prospective study. Lancet. 1975; 2 (7932) 421-424
- 4 Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986; 15 (5) 557-564
- 5 Samuel M. Pediatric appendicitis score. J Pediatr Surg. 2002; 37 (6) 877-881
- 6 Hernandez JA, Swischuk LE, Angel CA. et al . Imaging of acute appendicitis: US as the primary imaging modality. Pediatr Radiol. 2005; 35 (4) 392-395
- 7 Bhatt M, Joseph L, Ducharme FM. et al . Prospective validation of the pediatric appendicitis score in a Canadian pediatric emergency department. Acad Emerg Med. 2009; 16 (7) 591-596
- 8 Goldman RD, Carter S, Stephens D. et al . Prospective validation of the Pediatric Appendicitis Score. Journal of Pediatrics. 2008; 153 (2) 278-282
- 9 Puylaert JB. Acute appendicitis: US evaluation using graded compression. Radiology. 1986; 158 (2) 355-360
- 10 Puylaert JB. Ultrasonography of the acute abdomen: gastrointestinal conditions. Radiol Clin North Am. 2003; 41 (6) 1227-1242
- 11 Le Cessie S, Van Houwelingen JC. Ridge estimators in logistic-regression. Applied Statistics – Journal of the Royal Statistical Society Series C. 1992; 41 (1) 191-201
- 12 Mertens BJ, de Noo ME, Tollenaar RA. et al . Mass spectrometry proteomic diagnosis: enacting the double cross-validatory paradigm. J Comput Biol. 2006; 13 (9) 1591-1605
- 13 Olinde AJ, Lucas Jr JF, Miller RC. Acute yersiniosis and its surgical significance. South Med J. 1984; 77 (12) 1539-1540
- 14 Puylaert JB, Vermeijden RJ, van der Werf SD. et al . Incidence and sonographic diagnosis of bacterial ileocaecitis masquerading as appendicitis. Lancet. 1989; 2 (8654) 84-86
- 15 van Noyen R, Selderslaghs R, Bekaert J. et al . Causative role of Yersinia and other enteric pathogens in the appendicular syndrome. Eur J Clin Microbiol Infect Dis. 1991; 10 (9) 735-741
- 16 Blattner RJ. Acute mesenteric lymphadenitis. J Pediatr. 1969; 74 (3) 479-481
- 17 Flum DR, Koepsell T. The clinical and economic correlates of misdiagnosed appendicitis: nationwide analysis. Arch Surg. 2002; 137 (7) 799-804
- 18 Doria AS, Moineddin R, Kellenberger CJ. et al . US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology. 2006; 241 (1) 83-94
- 19 Brenner D, Elliston C, Hall E. et al . Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol. 2001; 176 (2) 289-296
- 20 Holscher HC, Heij HA. Imaging of acute appendicitis in children: EU versus US … or US versus CT? A European perspective. Pediatr Radiol. 2009; 39 (5) 497-499
- 21 Schneider C, Kharbanda A, Bachur R. Evaluating appendicitis scoring systems using a prospective pediatric cohort. Annals of Emergency Medicine. 2007; 49 (6) 778-784
Correspondence
B. Toorenvliet
Leiden University Medical
Center, Surgery
Albinusdreef 2
2300 RC Leiden
The Netherlands
Telefon: +31 71 526 4005
Fax: +31 71 521 6947
eMail: br.toorenvliet@tiscali.nl