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Park and Kim: Multi-Detector CT Findings of the Normal Appendix in Children: Evaluation of the Position, Diameter, and Presence or Absence of Intraluminal Gas
Pediatric Radiology
Original Article

Journal of the Korean Society of Radiology 2011; 65(2): 191-198.

Published online: 31 August 2011

DOI: https://doi.org/10.3348/jksr.2011.65.2.191

Multi-Detector CT Findings of the Normal Appendix in Children: Evaluation of the Position, Diameter, and Presence or Absence of Intraluminal Gas

Woon-Ju Park, M.D., Jongchul Kim, M.D.

Department of Radiology, College of Medicine, Chungnam National University, Daejeon, Korea.

Corresponding author: Jongchul Kim, MD. Department of Diagnostic Radiology, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 301-721, Korea. Tel. 82-42-220-7835, Fax. 82-42-253-0061, jckim@cnu.ac.kr

Received 5 April 2011       Accepted 7 June 2011

Copyright © 2011 The Korean Society of Radiology

Abstract

Purpose

To assess the usefulness of multi-detector CT (MDCT) with multiplanar reformations (MPR) for the evaluation of the position, diameter and presence or absence of intraluminal gas in the normal appendix in children.

Materials and Methods

From 2007 to 2010, we retrospectively analyzed the MDCT images of normal appendices in 133 children, and evaluated the position, diameter, and presence or absence of intraluminal gas in the appendix.

Results

Among the 133 appendices, type I (postileal and medial paracecal position) was found in 64 children, type II (subcecal position) in 22, type III (retrocecal and retrocolic/laterocolic position) in 15, type IV (preileal and medial colic position) in 16, and type V (lower pelvic position) in 16 children. The mean diameter was 5.8 mm ± 1.2 (SD) (range; 3.2-8.7 mm). There was a high correlation between the appendiceal diameter and age (p = 0.000).There was no statistically significant difference in the appendiceal diameter between boys and girls (p = 0.470). Intraluminal gas was found in 115 appendices and there was no statistically significant correlation between the appendiceal diameter and intraluminal gas (p = 0.502).

Conclusion

The MDCT with MPR was useful for the evaluation of the normal appendices in children. The procedure may be useful for the diagnosis of equivocal or unusual appendicitis in children.

Keywords: Appendix, CT, Children, Gastrointestinal Tract

Figures and Tables

Fig. 1

Schematic drawing of normal appendiceal position. Type I: postileal and medial paracecal area, Type II: subcecal area, Type III: retrocecal and retrocolic or laterocolic area, Type IV: preileal and medial colic area, Type V: lower pelvic cavity. Courtesy of Oh et al. (10)

Note.-pm = psoas muscle, pb = pelvic bone
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Fig. 2

CT images show five types of normal appendiceal position on contrast-enhanced multi-detector CT scans.

A. Coronal reformation image shows an appendix (arrow) with intraluminal gas in the medial aspect of the cecum, located between the terminal ileum and the psoas muscle (type I).
B. Coronal reformation image shows an appendix (arrow) with no intraluminal gas in the subcecal area (type II).
C. Axial image shows an appendix (arrow) with intraluminal gas in the retrocecal area (type III).
D. Coronal reformation image shows an appendix (arrow) with no intraluminal gas in the medial aspect of the ascending colon (type IV).
E. Coronal reformation image shows an appendix (arrow) with intraluminal gas extending to deep pelvis (type V).
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Fig. 3

CT images show unusual locations of appendiceal tip on contrast-enhanced multi-detector CT scans.

A, B. Axial image (A) and sagittal reformation images (B) show an appendiceal tip in anterior portion of mid vertrebral body at the L5 level.
C. Coronal reformation image shows an appendiceal tip (with intraluminal gas) of retrocolic appendix (arrows) extending to the subhepatic area.
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Fig. 4

The correlation between appendiceal diameter and age

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Table 1

Types of Appendiceal Position in Children

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