The onion skin sign: a specific sonographic marker of appendiceal mucocele.

OBJECTIVE: To evaluate the association of the onion skin sign as a sonographic marker for appendiceal mucocele. METHODS: The sonographic onion skin sign was considered specific for the preoperative diagnosis of appendiceal mucocele. Therefore, detection of this sign in a mass located in the right lower abdomen, unrelated to the female reproductive organs, indicated surgical intervention with a presumptive diagnosis of appendiceal mucocele. From 1998 through 2001, female patients who were found to have atypical cysts containing this sign underwent surgery. The cases were closely followed, and intraoperative findings and final histologic diagnoses were recorded. RESULTS: Appendiceal mucocele was the final diagnosis in all 7 patients in whom the onion skin sign was observed. One additional patient had an appendiceal mucocele with a sonographic picture of a clear tubular cystic structure. CONCLUSIONS: A sonographically layered cystic mass in the right lower quadrant of the abdomen in the presence of a normal ovary strongly suggests the diagnosis of appendiceal mucocele. Recognition of the sonographic onion skin sign in a cystic mass in the right lower quadrant may facilitate the accurate preoperative diagnosis of appendiceal mucocele.     

Endoscopic diagnosis and treatment of an appendiceal mucocele: A case report

BACKGROUNDAppendiceal mucocele is a rare disease that causes obstructive dilatation of the appendix due to the intraluminal accumulation of mucin. We report a case of endoscopic diagnosis and treatment of an appendiceal mucocele.CASE SUMMARYA 47-year-old man presented with a protrusion around the orifice of the appendix discovered by colonoscopy incidentally. He was admitted to our hospital for a routine checkup without any symptoms. Abdominal computed tomography showed a cystic mass approximately 3 cm in diameter with fat stranding. The preoperative diagnosis was non-neoplastic appendiceal mucocele, and endoscopic treatment was performed. The endoscopic findings and pathological results supported our preoperative diagnosis. The endoscopic treatment of appendiceal mucocele was feasible and effective, which was confirmed by repeated endoscopy and post-operative computed tomography after 7 mo. CONCLUSIONEndoscopic therapy provides a new method for the treatment of appendiceal mucocele.     

阑尾黏液性囊性病变的超声表现

目的 研究阑尾黏液性囊性病变超声表现,提高诊断准确性.方法 回顾分析16例病理证实阑尾黏液性囊性病变或其腹腔假黏液瘤患者超声资料.结果 阑尾单纯性黏液囊肿1例及囊腺瘤2例:肿块管状或类圆形;囊壁薄光滑;囊内点状均匀回声;1个肿块周围见无回声区;肿块未见血流信号.局限性阑尾黏液性囊腺癌7例:肿块椭圆形、类圆形及欠规则形;...     

阑尾黏液囊肿的CT影像诊断特点及临床分析

目的:分析阑尾黏液囊肿的CT影像诊断特点,提高该病诊断及鉴别诊断水平。方法:回顾性分析经手术病理证实的阑尾黏液囊肿患者12例,分析阑尾黏液囊肿的CT特点及注意事项进行分析。结果:CT扫描显示,5例患者右下腹可见低密度肿块,与盲肠关系密切;7例表现为位于右下腹的边缘光滑的囊性肿块,囊壁较薄,呈卵圆形或哑铃形,囊肿大小不一,直径2~10cm,平均直径(4.7±1.5)cm,囊内容物CT扫描值为8~18Hu;2例囊壁可见不同程度钙化;1例边缘不清,四周渗出,肠系膜脂肪间隙密度变高;5例进行增强扫描,2例无增强,3例囊壁轻度环形增强现象,囊内容物无明显增强现象。12例手术病理诊断为单纯黏液囊肿9例,阑尾黏液性囊腺瘤2例,黏液性囊腺癌1例。结论:阑尾黏液囊肿无特异性临床表现,其CT表现具有一定特征性,典型征象显示右下腹薄壁囊性肿块伴囊壁弧形钙化及盲肠受压,增强扫描显示囊壁呈轻度环行均一强化,囊内无强化,对术前诊断和良恶性的评估具有一定诊断价值。     

Evaluation of whether the ultrasonographic onion skin sign is specific for the diagnosis of an appendiceal mucocele

Purpose

To evaluate whether the onion skin sign on ultrasonography (US) of the lower abdomen is specific for the diagnosis of an appendiceal mucocele.

Methods

Our study included 231 lesions from 229 patients in whom transabdominal US detected lesions in the lower abdomen and who had definitive pathological diagnoses in the small bowel, ileocecal valve, cecum, appendix, mesentery, adnexa uteri or pelvic cavity outside the major organs. Patients with metastatic tumors were excluded. We reviewed the reports and images from transabdominal US and checked for the presence of the onion skin sign. The sensitivity, specificity, and accuracy of the sign for the diagnosis of an appendiceal mucocele were calculated.

Results

Five (2.2 %) of the 231 lesions showed the onion skin sign on US and all were diagnosed with an appendiceal mucocele. The sensitivity, specificity, and accuracy of the sign for the diagnosis of an appendiceal mucocele were 63, 100, and 99 %, respectively.

Conclusions

The onion skin sign in the lower abdomen appears to be specific for the diagnosis of an appendiceal mucocele. In cases where the onion skin sign is obviously present in the lower abdomen on US, an appendiceal mucocele should be considered as the leading diagnosis.     

Sonographic appearance of appendiceal mucocele.

We present a case of the diagnosis of an appendiceal mucocele in a 23-year-old woman. The unusual preoperative sonographic appearance of the lesion is described and its clinical significance and differential diagnosis are discussed.     

Single-incision laparoscopic partial cecectomy for appendiceal mucocele in a patient with porphyria photosensitivity

Erythropoietic protoporphyria (EPP) is a rare hereditary subtype of cutaneous porphyria characterized by photosensitivity. Increased exposure to light irradiation may precipitate acute liver failure, and surgical light-induced intestinal burns and perforations are known to occur. We report a case of EPP in a patient who underwent laparoscopic partial cecectomy for appendiceal mucocele. A 55-year-old man with EPP was presented for treatment of appendiceal mucocele. A light test using two types of laparoscopes (Companies O and S) was performed preoperatively. Light from the laparoscope manufactured by Company O caused photosensitivity; this effect was not observed with light from the laparoscope manufactured by Company S. Therefore, we performed laparoscopic partial cecectomy through a single umbilical incision using the laparoscope from Company S. Except for the incision site, the patient's skin was completely covered using surgical drapes. No intra- or postoperative complications were observed. Histopathological examination of the resected specimen revealed a low-grade appendiceal mucinous neoplasm.     

Mucinous appendiceal neoplasm: A case report

BACKGROUNDPrimary appendiceal tumors are histologically diverse and have an insidious onset and few specific clinical manifestations. In the majority of cases, these tumors are discovered after appendectomy during pathological exam of the resected tissue. Treatment may include appendectomy (simple or radical) and right hemicolectomy depending on factors such as histological type, tumor size and lymph node/organ involvement. The aim of this case study is to describe a rare case of a giant appendicular mucocele and raise awareness of this condition and its management options and follow-up protocol.CASE SUMMARYWe present the case of a 43-year-old patient who presented to our emergency department with mild right lower quadrant pain. After the initial check-up and imaging exams, he underwent surgery, where a giant 20 cm × 13 cm appendicular tumor was found and resected. Appendicular mucocele was suspected due to the macroscopic appearance and was later confirmed by the pathological exam. The patient’s postoperative evolution was uneventful, and after discharge, he was included in our follow-up program.CONCLUSIONIn conclusion, mucinous appendiceal neoplasms embody a rare pathology; they are asymptomatic or have few, unspecific clinical signs and in many cases are discovered after appendectomy.     

Preoperative sonographic diagnosis of appendiceal intussusception: A case report

Appendiceal intussusception is an uncommon form of intussusception. Most of the literature regarding appendiceal intussusception discusses the colonoscopic diagnosis or surgical treatment of the condition. Sonographic findings have rarely been described. We present a case of preoperative sonographic diagnosis of appendiceal intussusception. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2009     

Mucocele of the appendix: an important clinical rarity

Mucocele is an uncommon pathology of the vermiform appendix that can be confused with acute appendicitis. We present a case of an appendiceal mucocele associated with subacute, intermittent right lower quadrant discomfort. The diagnosis of appendiceal mucocele is an important one in that it can be associated with malignancies and other serious gastrointestinal, ovarian, and urological complications.     

Appendiceal outer diameter as an indicator for differentiating appendiceal mucocele from appendicitis

BACKGROUND: Patients with appendiceal mucocele (AM) commonly present with features indicative of acute appendicitis. In emergency departments, accurate preoperative diagnosis is crucial to prompt appropriate treatment. This study investigates the clinical and sonographic characteristics of AM, which may prove useful in preoperatively differentiating AM from appendicitis. METHODS: This case-control study compares the clinical and sonographic findings of 16 histologically confirmed AM with sex- and age-matched control subjects (n = 64) with appendicitis by a 1:4 ratio. Conditional logistic regression was applied to estimate the odds ratio (OR) and 95% confidence intervals (CI) of clinical and sonographic parameters associated with AM. RESULTS: Univariate analysis demonstrated that the larger appendiceal outer diameter by sonography was positively correlated with diagnosis of AM (OR, 2.31; 95% CI, 1.42-3.72) and right lower quadrant abdominal pain was negatively correlated (OR, 0.38; 95% CI, 0.17-0.82). However, multiple regression analysis suggested that only outer diameter remained significant (OR, 2.21; 95% CI, 1.36-3.59) after adjusting for age, sex, and right lower quadrant pain. An outer diameter of 15 mm or more was predictive of AM diagnosis, with a sensitivity of 83% and specificity of 92%. CONCLUSION: When the threshold is set at 15 mm, appendiceal outer diameter by sonography is a useful preoperative measurement for differentiating between AM and acute appendicitis.     

64排螺旋CT对阑尾黏液囊肿的CT诊断及其临床价值

目的：探讨64排螺旋CT在阑尾黏液囊肿诊断中的特征及临床价值.材料与方法：回顾性分析我院收治的14例阑尾黏液囊肿患者的临床资料,并对其64排螺旋CT诊断状况进行总结和分析.结果：14例患者的病灶呈大小不等的囊性肿块,9例呈类圆形、长管状,3例呈分叶状,2例呈“逗号”状,病灶部位处于右下腹近回盲部或右侧盆腔内.所有病灶都未发现分隔,内容物CT值为10～30 HU.8例增强扫描者中,2例囊壁未见强化,6例轻度强化.11例病灶附近结构清晰,其中2例与盲肠分解模糊,3例合并肠套叠突入盲肠内.结论：64层排螺旋CT临床诊断阑尾黏液囊肿的影像学具有明显特异性,可作为术前明确诊断的重要参考.     

Sonography of appendiceal intussusception

A case in which appendiceal intussusception was diagnosed preoperatively by sonography is described. The sonographic finding of multiple concentric hypoechoic and hyperechoic rings was confirmed at laparotomy to be due to appendiceal intussusception. Demonstration of the sonographic coiled spring sign in the right lower quadrant should raise the possibility of appendiceal intussusception. The differential diagnosis is discussed.     

Intussusception of a mucocele of the appendix

Intussusception by an appendiceal mucocele into the colon is illustrated and the literature reviewed.     

Adenocarcinoma of the appendiceal stump

We have reported the case of a 58-year-old woman with nonspecific abdominal complaints in whom barium enema and subsequent colonoscopy showed a 3 cm lobulated adenocarcinoma within a villous adenoma arising from the appendiceal stump. Because such appendiceal malignancies have no specific clinical signs, symptoms, or radiologic features, preoperative diagnosis is extremely difficult, and colonoscopy may be required to clarify radiologically demonstrated irregularities.     

Case of idiopathic and complete appendiceal intussusception

Appendiceal intussusception is a rare disease in which the appendix invaginates into the cecum. It is often caused by organic diseases. The present case involved an appendiceal intussusception without an organic disease, and laparoscopic resection of part of the cecum was performed. Appendiceal intussusception has various causes, including malignant diseases. Therefore, diagnosis and selection of operative method are complex and could potentially lead to an excessively invasive option. By performing SILS with a multiuse single‐site port, we were able to provide an appropriate, non‐invasive treatment that had a good esthetic outcome.     

Ultrasonographic findings in diseases of the appendix.

Ultrasonographic findings in patients with diseases of the appendix, including acute appendicitis, suspected appendiceal abscess, and palpable right-lower-quadrant abdominal mass, are described. An appendiceal abscess may manifest as a cystic mass, a mixed solid and cystic mass, or a hypoechoic solid mass. An appendiceal calculus within an abscess can be recognized as a hyperechoic structure with acoustic shadowing. On ultrasonography, acute appendicitis in female patients may mimic tubo-ovarian disease. Ultrasonographic features of isolated Crohn's disease of the appendix and mucocele of the appendix are also described.     

Synchronous mucinous tumors of the ovary and the appendix associated with pseudomyxoma peritonei: CT findings

Background: To present the computed tomographic (CT) findings of synchronous mucinous tumors of the ovary and the appendix associated with pseudomyxoma peritonei (PMP). Methods: Imaging studies, mainly abdominal CT scans, of three women aged 49–75 years were reviewed. Attention was directed to the ovarian masses, peritoneal seeding, and the presence of an appendiceal mucocele. Results: The ovarian tumors and the appendiceal mucocele were clearly demonstrated in two cases, and they were part of the extensive PMP in the third patient. Ascites was found in all cases, with internal septation in one. Associated scalloping of the liver margins and hypodense peritoneal implants, with extensive bowel involvement, were seen in another one. Pathologically, there was one case of right ovarian mucinous cystadenoma and villous adenoma of the appendix, one case of right ovarian and appendiceal mucinous cystadenocarcinoma, and one case of bilateral metastatic ovarian implants of appendiceal mucinous cystadenocarcinoma. PMP was found in all. In the case with benign tumors of the ovary and the appendix, the PMP was classified as a benign mucinous spillage. This patient returned 33 months after surgery with PMP, in which epithelial cells were found. Conclusions: Radiologists should be familiar with the clinical occurrence of synchronous mucinous tumors of the ovary and the appendix associated with PMP and with the typical CT findings of the latter two entities. Alternatively, when the imaging findings suggest ovarian cystic tumor with PMP, the radiologist should be alerted to the probability of a clinically unsuspected appendiceal mucocele and should search for it. Received: 10 August 1999/Accepted: 22 September 1999     

Mucocele of the vermiform appendix misdiagnosed as an adnexal mass on transvaginal sonography

Mucocele of the vermiform appendix is a rare entity that may mimic a right-sided adnexal mass. We describe a case of appendiceal mucocele in a 78-year-old woman that was initially misdiagnosed as a potentially malignant right ovarian tumor and briefly review the literature on sonographic features of this entity. It is important to improve preoperative diagnosis so as to prevent rupture of mucocele at surgery, which may lead to pseudomyxoma peritonei, and also to seek intraoperatively for the presence of synchronous colorectal neoplasms.     

Preoperative sonographic diagnosis of sliding appendiceal inguinal hernia

Rarely, the appendix forms the sliding component of an inguinal hernia. We report the case of a 2-month-old boy who was preoperatively diagnosed with sliding appendiceal inguinal hernia by sonographic examination. To our knowledge, this is the first report in the literature of the preoperative sonographic diagnosis of a sliding appendiceal inguinal hernia.