超声对急性阑尾炎阑尾周边高回声结构的分析

目的 探讨阑尾周边高回声结构的性质，评价其在急性阑尾炎超声诊断中的临床意义。方法 对75例急性阑尾炎患者声像图进行回顾性分析，并与手术及病理结果相对照，分析阑尾周边高回声结构与阑尾炎病理及病变现象之间的相互关系。结果 75例急性阑尾炎中阑尾周边高回声结构阳性者32例，阴性者43例。阳性者中单纯性阑尾炎2例，化脓性阑尾炎18例，坏疽性阑尾炎12例，分别占各阑尾炎类型总例数的13％（2／15），39％（18／46），86％（12／14），阑尾周边高回声结构阳性率与病理类型间呈正相关关系（r=0．451，P〈0．001），阑尾炎越严重，阑尾周边高回声结构阳性率越高。病理结果显示阑尾周边高回声结构阳性病例均伴有阑尾周围炎，且阑尾发生与周围组织粘连及穿孔的比率明显高于阑尾周边高回声结构阴性病例。结论 阑尾周边高回声结构是急性阑尾炎超声征象之一，是阑尾周围组织（大网膜、肠系膜脂肪）受炎症浸润发生急性炎性反应的表现，阑尾周边高回声结构阳性提示与周围组织粘连、阑尾穿孔等严重病变可能性大。     

Acute appendicitis mimicking infectious enteritis: diagnostic value of sonography.

OBJECTIVE: To verify the role of sonography in screening of acute appendicitis in patients admitted to an infectious disease unit for suspected acute infectious enteritis. METHODS: One hundred eighty consecutive patients (102 male and 78 female; age range, 5-72 years; mean age, 31 years) admitted for suspected infectious enteritis or typhoid fever were prospectively studied with abdominal sonography within 48 hours after admission. None of the patients had peritoneal irritation. Forty-six patients (25%) had white blood cell counts of more than 10,000/mm3 (range, 10,300-18,000/mm3). The diagnosis of acute appendicitis was made when a detectable appendix with an anteroposterior diameter of greater than 7 mm could be seen on sonography. RESULTS: Eleven (6%) of 180 patients had thickened appendixes (anteroposterior diameter range, 7-14 mm); 2 of them had periappendiceal abscesses. Four (36%) of 11 patients with acute appendicitis had high white blood cell counts. All sonographic diagnoses of acute appendicitis and periappendiceal abscesses were confirmed at surgery. Sonography ruled out acute appendicitis in 169 patients. In all of them, clinical and sonographic follow-up excluded the diagnosis of acute appendicitis. Normal appendixes were shown on sonography in 38 (22%) of 169 cases and were not detectable in 131 (78%) of 169. CONCLUSIONS: Sonography of the appendix is a useful method for early assessment of acute appendicitis in patients thought to have enteritis or typhoid fever.     

The small spleen: sonographic patterns of functional hyposplenia or asplenia

PURPOSE: Functional hyposplenia or asplenia (FAS) can be associated with potential fatal infections. The diagnosis of FAS is traditionally made on liver-spleen scintigraphy and finding Howell-Jolly bodies within erythrocytes. In this retrospective study, our goal was to identify any characteristic sonographic findings of the spleen in patients with FAS in an attempt to determine whether the diagnosis of FAS can be made sonographically. METHODS: In a review of all medical and sonographic records from the period of January 1, 1985, through December 31, 2001, we identified 24 patients (11 men, 13 women) in whom FAS had been diagnosed by liver-spleen scintigraphy (n = 13) or the finding of Howell-Jolly bodies (n = 11). The following sonographic parameters were determined: size of spleen (small, normal, or large), echotexture of the spleen (homogeneous versus inhomogeneous), echogenicity (isoechoic versus hyperechoic), presence of focal splenic lesions, and patterns of splenic vascularization as determined by color Doppler sonography (absent flow, hilar flow, or parenchymal flow). RESULTS: The spleen was small in 20 patients (83%) and normal in the other 4 (17%). Echotexture was homogeneous in 13 patients (54%) and inhomogeneous in 11 (46%). The spleen was isoechoic in 18 cases (75%) and hyperechoic in 6 (25%). Six patients (25%) had focal lesions. Color Doppler sonography showed absent flow in 4 patients (17%), hilar flow in 17 (71%), and hilar and parenchymal vascularization in 3 (12%). CONCLUSIONS: Sonographic findings in the spleen of patients with FAS are characterized predominantly by a small spleen with absence of parenchymal vascularization on color Doppler sonography in most cases. Future prospective studies will be necessary to confirm these findings and to determine whether FAS can be diagnosed reliably with sonography.     

Sonography of acute appendicitis in childhood: perforation versus nonperforation.

We evaluated the sonographic findings in 133 consecutive children referred for suspected appendicitis. Fifty-eight of these patients (44%) ultimately underwent surgery, with 54 of these proved to have acute appendicitis. Thirty-one (58%) of the 54 had nonperforated appendicitis, and 23 (43%) had evidence of perforation. Previously described sonographic findings that have been employed in the diagnosis of appendicitis were evaluated, with the presence or absence of these findings being compared in patients with non-perforated and perforated appendicitis. In those patients who did not undergo surgery, the following findings were documented and compared to the findings in patients with proved appendicitis: (1) an identifiable appendix and its sonographic characteristics, (2) fluid localized to the right peritoneal reflection or periappendiceal region, or both, (3) free pelvic fluid, and (4) right lower quadrant adenopathy. Our results suggest that high-resolution, real-time sonography, using graded compression, is very sensitive in the identification of acute nonperforated appendicitis. Perforated appendicitis, however, can be a more difficult diagnosis because the appendix frequently decompresses with perforation and yet may not "wall off" or form a well-defined abscess. As a result, the appendix can be very difficult to identify.     

Acute appendicitis and diagnostic value of sonography: A prospective study of 77 surgically proven cases

We present the results of a prospective study on 122 patients referred for suspected acute appendicitis. In total, 77 patients had surgically proven appendicitis. Of these 77 patients, sonography showed typical signs of appendicitis and/or peri-appendicular abscess in 57 cases (true positives); in the remaining 20 patients neither the inflamed appendix nor any related abnormal finding could be detected pre-operatively (false negatives). Forty-five patients were subsequently shown to have other disorders (related to the urinary or digestive tract, or to the female reproductive system); the final diagnoses were based on surgical findings in 16 patients, and on a combination of clinical, imaging and laboratory findings in the remaining 29 patients. In all these patients, no sonographic evidence of appendicitis was detected (true negatives), whereas in 33 cases the US exam was able to detect abnormal findings related to other conditions, thus suggesting a correct diagnosis. In the authors' experience, sonography has a good accuracy in diagnosing acute appendicitis. The sensitivity (75%) and specificity (100%) values were similar among the different examiners and in overall agreement with the literature data.     

The gas-containing appendix: potential sonographic pitfall in the diagnosis of acute appendicitis.

The presence of gas within the appendix on plain abdominal radiographs is nonspecific and may or may not be associated with acute appendicitis. This finding, however, has not previously been reported with graded compression sonography of the right lower quadrant. Gas within the appendix was identified in four of 154 patients with a visualized appendix. All four patients had surgically confirmed acute appendicitis. Diagnostic difficulties were encountered in three of these four patients. In two patients, the findings were misinterpreted as an extraluminal gas-forming periappendiceal abscess. In an additional patient, the gas-filled appendix was initially mistaken for a segment of normal terminal ileum. The gas-filled appendix is a potential pitfall in the sonographic diagnosis of acute appendicitis. However, if other diagnostic criteria are met, gas within the appendix should not preclude establishing a sonographic diagnosis of appendicitis.     

阑尾粪石征在急性阑尾炎CT诊断中的价值

目的探讨阑尾粪石征在多层螺旋CT(MSCT)诊断急性阑尾炎中的价值。方法回顾性分析60例经手术和病理证实的急性阑尾炎患者的CT表现。结果 60例急性阑尾炎患者中主要的CT征象有:阑尾粪石征36例(60.0%),阑尾肿胀伴阑尾周围炎(无阑尾粪石征)15例(25.0%),回盲部周围炎6例(10.0%),阑尾炎伴盲肠周围脓肿形成3例(5.0%),提示穿孔1例。所有患者均行急诊阑尾切除术,术后病理诊断为急性阑尾炎。结论阑尾粪石征在MSCT对急性阑尾炎的影像诊断中有着十分重要的意义。     

Real‐time Elastography in Acute Appendicitis

Objective. This study was done to evaluate the role of real‐time Elastography (ES) in the diagnosis and staging the severity of acute appendicitis. Methods. Forty patients with acute pain in the right iliac fossa were evaluated using ES and sonography. All patients with a diagnosis of acute appendicitis on ES were also staged for the severity of appendicular inflammation and later underwent surgery, and the findings on imaging were confirmed and results compared. The sensitivity and specificity for ES and sonography were then calculated. Results. Elastography had sensitivity and specificity of 100% each, whereas sonography had sensitivity of 88% and specificity of 100%. Elastography also depicted the severity of inflammation, with 12 patients having mild, 8 having moderate, and 5 having severe appendicitis. Conclusions. Combining ES with sonography improves the sensitivity in detection of acute appendicitis and can also be used to triage the severity of inflammation in such patients.     

Transvaginal sonography in the diagnosis of acute appendicitis.

OBJECTIVES: To evaluate transvaginal sonography with power Doppler capacity in the diagnosis of acute appendicitis and in discriminating appendicitis from pelvic inflammatory disease. PATIENTS AND METHODS: We describe transvaginal sonographic findings of six women with acute appendicitis selected from 31 women seen in an emergency room setting for clinically suspected pelvic inflammatory disease. The study population underwent gray-scale transvaginal sonography, and specific sonographic landmark findings for acute appendicitis and pelvic inflammatory disease were used. Hyperemia of any infectious complex was identified by power Doppler. Laparoscopy was performed after transvaginal sonography and was used as the gold standard. RESULTS: Laparoscopy showed acute appendicitis in six (19%) of the 31 patients. A thick walled non-compressible gas-containing tubular structure with a diameter exceeding 6 mm was seen by transvaginal sonography in four of the six cases, consistent with uncomplicated appendicitis. A heterogeneous complex with surrounding hyperechogenic soft tissue was seen in two cases with gangrenous appendicitis. Power Doppler detected hyperemia in all six cases. Normal adnexal structures were imaged next to the inflamed appendix. The sonographic criteria consistent with acute appendicitis were clearly different from those of acute pelvic inflammatory disease. CONCLUSIONS: Transvaginal sonography provides an opportunity to distinguish between appendicitis and acute pelvic inflammatory disease. Prospective trials are needed in order to evaluate the impact of transvaginal sonography in the diagnosis of acute appendicitis.     

Comparison between technetium 99m hexamethylpropyleneamine oxide labeled white blood cell abdominal scan and abdominal sonography to detect appendicitis in adult patients with atypical clinical presentation

BACKGROUND: Acute appendicitis is much more serious in the elderly, and early diagnosis is very important. However, the diagnosis of acute appendicitis in older patients is often difficult because these patients may present with atypical clinical manifestations. METHODS: We conducted a prospective study to evaluate and compare the value of technetium 99m hexamethylpropyleneamine oxide (Tc 99m HMPAO) labeled white blood cell (WBC) abdominal scan and abdominal sonography in the diagnosis of acute appendicitis in older patients with an atypical clinical presentation. Forty-nine patients (age > 50 years) with acute abdominal pain and suspected appendicitis, but with atypical findings, were included in this study. RESULTS: Twenty-seven patients received laparotomy for final surgical and pathologic diagnoses. The remaining 22 patients did not receive surgery and showed no evidence of appendicitis after at least 1 month of follow-up. Two patients had false-positive WBC scan findings and two patients had false-negative WBC scan findings. The overall sensitivity, specificity, and accuracy for WBC scans in diagnosing appendicitis were 92.0%, 91.7%, and 91.8%, respectively. The overall sensitivity, specificity, and accuracy for abdominal sonography in diagnosing appendicitis were 84.0%, 95.8%, and 89.8%, respectively. CONCLUSION: The Tc 99m HMPAO WBC scan provides a more sensitive and accurate method for diagnosing appendicitis in older patients with equivocal clinical examinations when compared with abdominal sonography.     

急性阑尾炎的CT表现

目的 探讨急性阑尾炎的CT表现。方法 对68例手术、病理证实为急性阑尾炎病人的腹部CT资料进行回顾性分析，对阑尾大小、有无阑尾结石、阑尾周围及盲肠末端的改变作了观察、分析。结果 68例中61例CT诊断为急性阑尾炎，7例假阴性，CT诊断急性阑尾炎的敏感性为89．7％。急性阑尾炎的CT表现主要有阑尾增粗(76．5％)，阑尾结石(29．4％)，阑尾周围炎性改变(66．2％)，阑尾脓肿(13．2％)，蜂窝织炎(10．3％)，盲肠末端肠壁增厚(7．4％)和局部淋巴结肿大(5．9％)。结论 急性阑尾炎可出现多种CT表现，熟悉这些表现有助于提高CT诊断阑尾炎的准确性。     

Granulomatous mastitis: gray-scale and color Doppler sonographic findings

PURPOSE: We examined the roles of gray-scale and color Doppler sonography in the diagnosis of granulomatous mastitis. METHODS: We retrospectively studied the clinical, mammographic, and sonographic findings in 10 women 24-57 years old (mean age, 35.9+/-13.9 years) who had a histopathologic diagnosis of granulomatous mastitis. All patients underwent gray-scale sonographic examination, and 8 patients were further examined with color Doppler imaging. Seven patients had previously undergone mammography. RESULTS: Mammographic findings were nonspecific in all 7 patients. Gray-scale sonographic findings were compatible with mastitis in 6 (60%) of 10 patients. Doppler examination showed increased arterial and venous vascularization within and around the lesion in 5 of 8 patients, but the spectral analysis findings were not specific for granulomatous mastitis. CONCLUSIONS: Neither mammography nor Doppler sonography plays a significant role in the differential diagnosis of granulomatous mastitis versus fibroadenoma or carcinoma. Gray-scale sonography shows findings specific for granulomatous mastitis in some cases, but all cases require histopathologic confirmation for final diagnosis.     

二维及彩色多普勒超声对回盲区病变的诊断价值

目的　探讨二维及彩色多普勒超声对回盲区病变诊断的临床价值。方法　对右下腹疼痛或包块为主诉患者行二维及彩色多普勒超声检查。结果　 12 9例回盲区病变中急性阑尾炎 65例 (5 0 .4% ) ,急性阑尾炎并周围脓肿 2 0例(15 .5 % ) ,阑尾黏液囊肿 3例 (2 .3 % ) ,盲肠或回肠末端腺癌 2 5例 (19.4% ) ,肠套叠 8例 (6.2 % ) ,回肠末端淋巴瘤 3例(2 .3 % ) ,Crohn病 1例 (0 .78% ) ,回盲部结核 1例 (0 .78% ) ,回盲部结石 3例 (2 .3 % ) ,全部病例均经手术、内镜、病理或治疗后复查证实。结论　回盲区是肠道疾病的高发区 ,二维和彩色多普勒超声对回盲区病变有良好的发现效果 ,有助于临床诊断和鉴别诊断。     

Sonographic findings of rotator cuff calcifications.

We studied the findings and value of sonography in the diagnosis of rotator cuff calcifications in comparison to plain radiographs. Sonograms were correlated with plain radiographs in 951 patients. The diagnosis of rotator cuff calcifications was made by ultrasonography in 87 and with plain films in 93 of 951 patients. Sonography displayed two additional bursal slurry calcifications were found on plain films. Three types of calcifications were found with ultrasonography: (1) a hyperechoic focus with a well-defined shadow (79%); (2) a hyperechoic focus with a faint shadow (14%); and, (3) a hyperechoic focus with no shadow (7%). Large and slurry calcifications and bursal calcifications were better seen with ultrasonography, but small and more scattered deposits were better found on plain radiographs. Sonography proved to be reliable in the detection and localization of rotator cuff calcifications, but classification into a formative or resorptive phase could not be done. Because of this and the possibility of pathologic conditions of bone, plain radiographs should always be obtained prior to doing sonography.     

急性阑尾炎16排螺旋CT低剂量腹部平扫并重建的CT征象及临床价值分析

目的:对急性阑尾炎16排螺旋CT低剂量腹部平扫并重建的CT征象及临床价值进行分析研究。材料与方法:随机抽取80例经手术病理证实的急性阑尾炎患者作为研究对象,所有患者均具有完整的CT检查资料,对其进行回顾性分析。结果:本组研究中CT诊断的符合率为95.0%;CT直接征象为管壁增厚,阑尾增粗,阑尾内结石,间接征象为阑尾周围脓肿,邻近回盲部肠壁增厚,阑尾浆膜面模糊及阑尾周围炎性改变。结论:16排螺旋CT低剂量腹部平扫及重建可清晰显示急性阑尾及其周围病灶,在临床诊断急性阑尾炎方面确诊率较高,其具有积极的应用价值。     

内镜逆行阑尾炎治疗术诊治急性阑尾炎的初步尝试

目的:探讨内镜逆行阑尾炎治疗术(endoscopic retrograde appendicitis therapy, ERAT)诊治急性阑尾炎的临床意义。方法:回顾性分析2018年1月至2019年9月复旦大学附属金山医院收治的30例行ERAT治疗的急性单纯性、化脓性、穿孔性阑尾炎和阑尾周围脓肿患者的临床资料。术后通过门诊或电话进行随访,分析ERAT治疗成功率、治疗后情况以及随访情况。结果:在30例急性阑尾炎患者中,ERAT成功治疗29例,成功率为96.7%(29/30)。此29例患者腹痛症状均即刻缓解。随访过程中,1例患者复发,复发率为3.4%(1/29)。结论:ERAT可有效、安全地治疗急性阑尾炎。     

Sonography in the Evaluation of Acute Appendicitis

Objective. The purpose of this study was to evaluate the negative predictive value (NPV) of sonography in the diagnosis of acute appendicitis. Methods. Right lower quadrant sonograms of 193 patients (158 female and 35 male; age range, 3–20 years) with suspected acute appendicitis over a 1‐year period were retrospectively reviewed. Sonographic findings were graded on a 5‐point scale, ranging from a normal appendix identified (grade 1) to frankly acute appendicitis (grade 5). Sonographic findings were compared with subsequent computed tomographic (CT), surgical, and pathologic findings. The diagnostic accuracy of sonography was assessed considering surgical findings and clinical follow‐up as reference standards. Results. Forty‐nine patients (25.4%) had appendicitis on sonography, and 144 (74.6%) had negative sonographic findings. Computed tomographic scans were obtained in 51 patients (26.4%) within 4 days after sonography. These included 39 patients with negative and 12 with positive sonographic findings. Computed tomography changed the sonographic diagnosis in 10 patients: from negative to positive in 3 cases and positive to negative in 7. Forty‐three patients (22.2%) underwent surgery. The surgical findings were positive for appendicitis in 37 (86%) of the 43 patients who had surgery. Patients with negative sonographic findings who, to our knowledge, did not have subsequent CT scans or surgery were considered to have negative findings for appendicitis. Seven patients with negative sonographic findings underwent surgery and had appendicitis; therefore, 137 of 144 patients with negative sonographic findings did not have appendicitis. On the basis of these numbers, the NPV was 95.1%. Conclusions. Sonography has a high NPV and should be considered as a reasonable screening tool in the evaluation of acute appendicitis. Further imaging could be performed if clinical signs and symptoms worsen.     

“Tethered Fat Sign”: The Sonographic Sign of Omental Infarction

Our purpose is to describe the ultrasound sign for a correct non-invasive diagnosis of omental infarction in children. From January 2014 to December 2018, a total of 234 children (109 boys and 125 girls, age range 3–15 y) with acute right-sided abdominal pain, admitted to our hospital with a presumptive diagnosis of acute appendicitis, were prospectively evaluated. In all patients, abdominal ultrasound was performed, and the omental fat was always evaluated. In 228 patients, the omental fat resulted to be normal or hyperechogenic, never tethered, and they results affected by other causes of abdominal pain different from omental infarction (such as appendicitis, pancreatitis, urolithiasis and others). In the remaining 6 children, we found a hyperechoic mass between the anterior abdominal wall and the ascending or transverse colon in the right abdomen quadrant, suggesting the diagnosis of omental infarction. This subhepatic mass was always tethered to the abdominal wall, motionless during respiratory excursions. We named this finding the “tethered fat sign.” The diagnosis was confirmed with laparoscopy in 4 children. The other 2 children were treated with conservative therapy. In these 2 patients, a sonographic follow-up was performed, showing a progressive reduction in size of the right-sided hyperechoic mass. In conclusion, our study suggests that the presence of the “tethered fat sign” may be an accurate sonographic sign for non-invasive diagnosis of omental infarction in children.     

Sonography of acute appendicitis in pregnancy

Background: Clinical evaluation of acute appendicitis is difficult in pregnant patients. Delay in diagnosis is associated with increased fetal mortality. The purpose of our study was to assess the value of sonography in the diagnosis of acute appendicitis in pregnant women. Methods: We obtained sonograms in 22 pregnant women suspected of acute appendicitis. All sonograms were performed using graded-compression to detect an enlarged appendix. The sonographic criteria for acute appendicitis were detection of a noncompressible blindended and tubular multilayered structure of maximal diameter greater than 6 mm. Results: The sonographic findings were correlated with surgical findings in seven cases and clinical follow-up in 15 cases. Acute appendicitis was diagnosed by sonography in three of 22 patients, and in all but one was confirmed by surgical and pathologic findings. In the remaining 19 patients, 15 improved on clinical follow-up; three were shown to have a normal appendix at surgery and one had focal acute inflammation at the tip of the appendix. Conclusions: Our experience suggests that graded-compression sonography is a useful procedure in pregnant patients suspected of acute appendicitis and has a similar accuracy as in nonpregnant women, especially in the first and second trimester.     

Accuracy of ED sonography in the diagnosis of acute appendicitis

The objective was to compare the accuracy of abdominal sonography performed by emergency physicians in the diagnosis of acute appendicitis with that of the surgeons' clinical impression. Three hundred-seventeen patients with right lower abdominal pain admitted to the Department of Emergency Medicine at National Taiwan University Hospital in Taipei, Taiwan were prospectively included in this study. Patients were divided into two groups according to the time of day they visited the emergency department. Those patients visiting the emergency department during the day were included in group I and those during the night were in group II. Group I was diagnosed by sonography. Group II was diagnosed by surgeons' clinical impression without sonographic examination. The definitive diagnosis of acute appendicitis was confirmed by the pathological reports. In the diagnosis of acute appendicitis, group I had a sensitivity of 96.4%, a specificity of 67.6%, a positive predictive value of 89.8%, a negative predictive value of 86.2%, and an accuracy of 89.1%, and group II had a sensitivity of 86.2%, a specificity of 37.0%, a positive predictive value of 74.6%, a negative predictive value of 55.6%, and an accuracy of 70.6%. The overall accuracy of sonography performed by emergency physicians in the diagnosis of acute appendicitis was superior to that of the surgeons' clinical impression.