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FIGURE 116.1 Diagnostic algorithm for a child with suspected appendicitis. (Adapted from
Children’s Hospital of Philadelphia clinical pathway.)

Generally, children with suspected appendicitis should undergo US as the firstline imaging modality ( Fig. 116.2 ). The exception to this may be adolescent
males with convincing clinical and laboratory findings of appendicitis where the
patient may be confidently diagnosed without imaging. US is crucial as part of
the workup of adolescent females if gynecologic conditions such as ovarian cyst,