The Relationship Between CT Values and Ultrasonographic Findings Regarding Fecaliths in Seven Cases of Pediatric Acute Appendicitis

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  • 糞石のCT値と超音波像を比較検討した小児急性虫垂炎7例

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We have experienced some pediatric cases with acute appendicitis in whom masses in the vermiform appendix have not been recognized on ultrasonographic examination (US) as fecaliths without high-echoic signal as compared to the wall of the vermiform appendix, but which were detected in plain computed tomography (CT). To resolve this question, the correlation between CT values and ultrasonographic findings was investigated in seven pediatric cases with fecaliths. The range of the CT value was between 63.5 and 231.0 Hounsfield units (H.U.). A fecalith in two cases with HU values of 147.4 and 231.0 was observed as an atypical pattern, iso-low-echoic signal without acoustic shadow (AC), with 5MHz US. On the other hand, three cases with HU values from 63.5H.U. to 108.5H.U. showed the typical pattern of a high-echoic signal with AC by the same method. The cases with H.U. values of 147.4 and 231.0 demonstrated the typical pattern with 9MHz US. In conclusion, it is important to use high frequency US for detection of fecalith, and that CT imaging with soft-tissue window settings (window width, 250-300 ; window level, +30) should be performed to detect fecaliths, high density of fat-tissue, and ascites only in suspected cases of acute appendicitis.

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