Clin Imaging. 2025 Feb:118:110371. doi: 10.1016/j.clinimag.2024.110371.Epub 2024 Nov 26.

Ronnie W AlRamahi ¹, Andrew Woerner ², Hassan Rizvi ³, Eric J Monroe ³

Author information

¹Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792, United States of America. Electronic address: ronniealramahi@gmail.com.

²Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195, United States of America.

³Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792, United States of America.

Abstract

This pictorial review provides a comprehensive visual and textual overview of interventional radiology approaches in treating complicated appendicitis and other abdominal abscesses in children. This review discusses the incidence and complications associated with appendicitis in pediatric patients, highlighting the role of percutaneous drainage in managing appendicitis with abscesses. We present common mimics of intra-abdominal abscesses from other diseases such as tubo-ovarian abscesses, inflammatory bowel disease, and lymphomatous bowel involvement, emphasizing imaging pitfalls that can mimic appendiceal abscesses. The review also covers interventional radiology considerations, including antibiotic indications, local anesthesia considerations for children, the comparison between percutaneous and endocavitary approaches, and the roles of fibrinolytics are discussed here. Detailed discussions on catheter selection and insertion techniques, such as Seldinger and trocar, are provided along with post-procedure management strategies. These include drain maintenance, navigating drain associated complications, and determining when to remove the drain. Through high-quality images and concise descriptions, we illustrate procedural intricacies and clinical scenarios encountered in practice, offering a valuable educational resource for clinicians managing pediatric abscesses.