高频超声在小儿肠系膜淋巴结炎及急性阑尾炎鉴别中的应用

目的 探讨小儿肠系膜淋巴结炎及急性阑尾炎高频超声像图的特征及两种疾病的超声鉴别.方法 对2010年6月至2012年6月临床确诊的48例肠系膜淋巴结炎及23例急性阑尾炎患儿的临床资料进行回顾性分析,分析其高频超声的主要表现及间接征象.结果 高频超声诊断的48例肠系膜淋巴结炎患儿全部经临床证实,23例急性阑尾炎中,高频超声诊断与临床诊断一致为20例,其中经手术证实15例,5例结合临床确诊;误诊3例,1例将单纯性阑尾炎误诊为肠系膜淋巴结炎,1例腹膜后阑尾超声未能查出,1例将梅克尔憩室误诊为急性阑尾炎.结论 高频超声在小儿肠系膜淋巴结炎及急性阑尾炎的鉴别诊断中具有较高价值,是首选的辅助诊断的方法之一.     

超声在小儿肠系膜淋巴结炎和急性阑尾炎鉴别中的应用77例分析

目的探讨高频超声对小儿肠系膜淋巴结肿大和急性阑尾炎的鉴别诊断价值。方法对2~13岁77例急性腹痛的小儿进行腹部超声检查,观察肠系膜淋巴结和阑尾。结果超声诊断肠系膜淋巴结炎的56例患儿,声像图均可见肿大淋巴结。超声诊断为急性阑尾炎21例患儿,超声显示肿大阑尾18例,诊断符合率85.7%。结论高频超声在小儿肠系膜淋巴结炎和急性阑尾炎的诊断和鉴别诊断中具有实用价值,可为临床提供可靠的诊断依据,是临床鉴别诊断的必要方法。     

高频超声对小儿肠系膜淋巴结炎和急性阑尾炎的鉴别诊断价值

目的：探讨高频超声对小儿肠系膜淋巴结炎和急性阑尾炎的鉴别诊断价值。方法：回顾分析80例肠系膜淋巴结炎、30例急性阑尾炎的声像图特点,均经临床诊疗或病理确诊。结果：80例淋巴结炎超声均可探及3枚以上肿大淋巴结,30例急性阑尾炎超声25例肿大阑尾,诊断符合率83.3%（25/30）,漏误诊5例。结论：高频超声在小儿肠系膜淋巴结炎和急性阑尾炎鉴别诊断中有重要作用,是首选的检查方法。     

高低频超声在小儿急腹症诊断中的应用60例分析

目的探讨高低频超声在小儿急腹症诊断中的价值。方法回顾分析2008-2010年沈阳市第四人民医院急诊超声检查的急腹症患儿60例。结果急性肠系膜淋巴结炎32例,肠套叠22例,阑尾炎6例。结论彩色超声对于儿童急腹症的诊断方便、快捷、准确率高,对临床的诊断和治疗有重要的价值。     

高频超声诊断肠系膜淋巴结炎

肠系膜淋巴结炎超声报道尚少，而小儿肠系膜淋巴结炎在腹痛就诊小儿的发现率很高，有一大部分临床考虑急性阑尾炎患儿结果超声检查发现为肠系膜淋巴结炎，经过非手术治疗后，淋巴结明显缩小或消失，现就近年来所检测的肠系膜淋巴结炎进行总结。     

高频超声在鉴别及诊断小儿急性阑尾炎和急性肠系膜淋巴结炎中的应用

目的:研究高频超声对小儿急性阑尾炎和急性肠系膜淋巴结炎的鉴别和诊断效果。方法:选取我院收治的50例肠系膜淋巴结炎患儿和急性阑尾炎患儿,其中肠系膜淋巴结炎患儿42例,急性阑尾炎患儿8例。患儿入院后全部进行高频超声诊断,对两组患儿的临床指标和检出率进行对比和分析。结果:两种疾病的患儿在临床指标数据上相比较,差异显著,具有统计学意义(P<0.05);且两种疾病的患儿在检出率上的数据对比也具有显著差异,具有统计学意义(P<0.05)。结论:高频超声对小儿急性阑尾炎和急性肠系膜淋巴结炎的诊断率较高,且高频超声下患儿的临床指标均可明显诊断,具有较高诊断价值,值得大力推广。     

小儿肠系膜淋巴结炎的彩色多普勒超声诊断

目的探讨彩色多普勒超声对小儿肠系膜淋巴结炎诊断价值。方法将71例彩色多普勒超声检查诊断为肠系膜淋巴结炎患儿的淋巴结大小、数目及血流情况与33例正常组的彩色多普勒超声检查肠系膜淋巴结的情况进行统计、对比分析。结果71例彩色多普勒超声诊断为肠系膜淋巴结炎的患儿中,5例剖腹探查诊断为阑尾炎合并阑尾周围淋巴结肿大,5例失访。余61例患儿淋巴结大小、同一切面淋巴结数目与正常组比较,差异有统计学意义（P〈0．01）,淋巴结内血流情况与正常组比较,差异有统计学意义（P〈0．05）。结论彩色多普勒超声在肠系膜淋巴结炎的诊断中有重要的意义,是临床诊断小儿肠系膜淋巴结炎的首选辅助检查方法之一。     

儿童肠系膜囊肿及继发病变超声表现

目的总结儿童肠系膜囊肿及继发病变超声表现,评价超声诊断儿童肠系膜囊肿及继发病变的价值。方法对2005年1月至2010年12月我院收治的经手术及病理证实的41例肠系膜囊肿患儿超声表现和手术所见进行对比分析。结果本组41例肠系膜囊肿患儿共42个病灶,其中单发40例,多发1例。42个肠系膜囊肿病灶中,超声呈单房囊性(4个)或多房囊性(37个)包块;肠系膜囊肿超声声像图表现为形态规则的单房囊性团块或边缘不规则、囊腔大小不一、形态不一的多房囊性团块,囊内回声因成分不同而不同。本组8例肠系膜囊肿患儿继发出血,超声检查示出血囊腔张力增高、透声减低;6例患儿肠系膜囊肿及肠扭转并肠梗阻,超声检查可见肠管积液扩张及扭转肠系膜的"集束征"或"漩涡征";4例患儿继发感染,超声检查示囊肿壁增厚、周围见低回声索条。本组41例肠系膜囊肿患儿42个病灶术前超声诊断正确39个,超声诊断符合率92.9%(39/42),术前超声误诊3个,分别误诊为大网膜囊肿1个、肠重复畸形1个、肠系膜淋巴血管瘤1个;本组肠系膜囊肿合并症诊断符合率为66.7%(12/18),术前超声漏诊6例,分别为出血3例、肠梗阻1例、感染2例。结论超声检查对儿童肠系膜囊肿可作出定性诊断,对其并发症诊断也有很高的价值。超声检查应作为儿童肠系膜囊肿首选影像学检查方法 。     

超声及CT检查对小儿急性阑尾炎的诊断价值

目的:探讨超声及CT检查对小儿急性阑尾炎的诊断价值.方法:回顾分析因临床症状怀疑阑尾炎而行超声及CT检查的85例患儿的超声声像图及CT影像资料,并与手术病理结果和最终诊断结果进行比较.结果:85例中,接受手术治疗70例,其中急性单纯性阑尾炎2例,急性化脓性阑尾炎59例,急性坏疽性阑尾炎8例,阑尾周围脓肿1例;其余15例行保守治疗,临床最终证实为阑尾脓肿.85例患儿中,超声诊断的符合率为88.2 ％(75/85),CT诊断的符合率为94.1％(80/85).其中55例合并阑尾穿孔的患儿,超声诊断符合率为90.9 ％(50/55),CT诊断符合率为98.2 ％(54/55).结论:超声及CT检查对小儿急性阑尾炎均有较高的诊断价值,超声检查可作为小儿急性阑尾炎首选的影像学检查方法,当超声检查为阴性而临床症状典型时可选择CT检查.     

超声诊断儿童急性肠系膜淋巴结炎的应用价值

急性肠系膜淋巴结炎是儿童急性腹痛的常见原因之一，临床表现为上呼吸道感染后出现腹部隐痛或痉挛性痛，超声表现为淋巴结肿大。2002年9月至2007年8月，本科对急性腹痛患儿的超声检查中诊断急性肠系膜淋巴结炎208例。现作一回顾性分析，报告如下。     

急性阑尾炎的超声诊断价值

目的 探讨超声对急性阑尾炎的诊断价值。方法 对85例临床疑诊为急性阑尾炎的患进行超声检查,常规扫查右肾、右输尿管、右附件区,然后于右下腹阑尾区及患提示腹部疼痛最明显的部位进行多切面扫查,寻找并观察阑尾的形态、大小、腔内回声及周围组织改变。结果 85例中,超声诊断急性阑尾炎72例,其中急性单纯性阑尾炎28例;急性化脓性阑尾炎27例;阑尾穿孔或周围脓肿17例。右输尿管下段结石6例,右侧卵巢囊肿蒂扭转1例,超声未能提供阳性诊断6例。结论 超声对临床疑诊的急性阑尾炎具有明确诊断及鉴别诊断的价值,并可根据其特征性声像图表现对急性阑尾炎发展程度进行一定的病理解剖上的分析,不失为一种有效的诊断方法。     

阑尾黏液性肿瘤超声误漏诊分析

目的探讨阑尾黏液性肿瘤的超声表现,以期提高超声对其的诊断能力。 方法回顾性分析2013—2019年在北京市延庆区医院经手术病理证实的10例阑尾黏液性肿瘤病例的超声声像图特征,分析误诊及漏诊情况。 结果10例经手术病理证实为阑尾黏液性肿瘤的患者中,术前3例超声诊断或怀疑为阑尾黏液性肿瘤（30.0%,3/10）,6例超声诊断为急性阑尾炎（60.0%,6/10）,1例超声诊断为右下腹囊性包块,阑尾来源可能（10.0%,1/10）。10例患者的超声表现均为阑尾管径增宽,管壁增厚,其中5例阑尾管腔内可见沉积物,1例管腔内可见块状强回声,4例阑尾管壁结构不清合并周围积液。 结论阑尾黏液性肿瘤是一种少见疾病,超声表现具有一定的特异性,超声医师应掌握其临床及超声特点,提高对该疾病的认识,可提高本病的超声诊断率。     

阑尾粘液性肿瘤超声误诊分析

目的 探讨阑尾粘液性肿瘤超声误诊的原因。方法 回顾性分析 2014 年 4 月-2018 年 4 月在我院就诊的经术后病理证实的 13 例阑尾粘液性肿瘤患者 的超声声像图表现。结果 13 例患者中,二维超声声像图特征分别为：4 例表现 为盆腹腔内巨大低回声肿块伴腹腔积液;1 例表现为右侧附件区无回声,张力差; 5 例表现为右侧附件区以囊性为主的混合回声;3 例表现为典型的右下腹阑尾区 肿大的具有盲端的低回声管状结构伴周围少许无回声区。超声诊断分别为：9 例 患者诊断为卵巢来源的恶性肿瘤;1 例患者诊断为输卵管来源的囊性肿物;3 例 患者诊断为急性阑尾炎并周围渗出。结论 阑尾粘液性肿瘤为临床罕见病。超声 声像图表现不典型。当病变体积较大时,超声难以准确定位,极难与右侧卵巢及 输卵管来源的肿瘤相鉴别。而对于病变体积相对较小的患者,虽然超声能够相对 准确的定位病变来源,但因超声声像图表现与阑尾的炎症性改变相重叠,极易误 诊为阑尾炎。故而,对于超声不能准确定位以及超声怀疑阑尾炎的患者,其他的 影像学诊断可以作为一种补充。     

Granulomatous appendicitis presenting as right lower quadrant pain: CT findings

Background: We present the computed tomographic (CT) findings of granulomatous appendicitis. Methods: Five of 652 (0.9%) patients who had undergone appendectomy for clinically suspected acute appendicitis over a 19-month period proved to have granulomatous appendicitis. One patient had surgery based on a clinical diagnosis of acute appendicitis. Four patients (three men and one woman; age range = 14–39 years) underwent abdominal CT. The CT findings were retrospectively reviewed with special attention to the appendiceal abnormalities. Results: All four patients presented with subacute clinical presentation. Enlarged appendices of 4.5 and 2 cm in diameter with thickened walls of soft tissue density were found in two patients, and periappendicular inflammatory masses were found in the other two. Enlarged mesenteric lymph nodes and right lower quadrant fat stranding was seen in all four patients. Histopathology showed numerous granulomas within the inflamed appendix. Conclusion: Radiologists should be familiar with the rare entity of granulomatous appendicitis in patients examined by CT for suspected acute appendicitis. An insidious clinical presentation with CT findings of an exceptionally large appendix and associated periappendiceal inflammatory changes should raise the possibility of granulomatous appendicitis or carcinoma or lymphoma of the appendix.     

正常阑尾的多排螺旋CT研究

目的：分析正常阑尾的多排螺旋CT表现,提高阑尾早期病变的诊断能力。方法：入选100例经临床诊断排除阑尾炎、阑尾手术史及阑尾其他疾病的患者,采用多排螺旋CT行腹部扫描,准直0．6mm或1．2mm,在工作站上对阑尾进行多平面重建（MPR）、曲面重建（CPR）;测量阑尾直径、阑尾壁厚度、阑尾腔内液体的最大直径,并观察阑尾腔内有无粪石、气体,阑尾周围表现。结果：100例患者中,cT显示阑尾95例,敏感性为95％。正常阑尾直径3～10mm。平均为6．3±1．1mm。直径大于6mm者52例（52％）;阑尾壁厚度1～4mm,平均为2．6±0．5mm,大于3mm者25例（25％）。阑尾腔内有液体者17例,其中,直径大于2．6mm者2例;阑尾腔内有气体者58例（58％）;阑尾腔内有粪石者22例（22％）。阑尾壁钙化者14例（14％）。未见阑尾周围脂肪内出现条索状密度影。结论：多排螺旋CT阑尾重建能清晰地显示阑尾正常结构,有助于阑尾早期病变的诊断。     

It is not always appendicitis

BACKGROUND: Patients who are suspected of having acute appendicitis usually undergo surgery in order to avoid life-threatening complications such as perforation and peritonitis. However, acute appendicitis is difficult to distinguish from other sources of right-sided abdominal pain. The clinical picture is almost indistinguishable from appendiceal diverticulitis, which is a rare entity and remains a difficult diagnostic problem. PATIENTS AND METHODS: We describe the case of a 39-year-old male with perforated appendiceal diverticulitis. The patient was admitted to our surgical unit with acute appendicitis-like symptoms and underwent surgery with a diagnosis of suspected acute appendicitis. RESULTS: The patient was found to have perforated appendiceal diverticulitis and standard appendectomy with abdominal lavage was carried out. DISCUSSION: Most patients presenting with acute right-sided peritonitic pain are diagnosed and managed as cases of acute appendicitis. Acute pain in the lower right side of the abdomen caused by appendiceal diverticulitis is very rare and clinically indistinguishable from acute appendicitis. Inflammatory complications of appendiceal diverticula mimic acute appendicitis. CONCLUSION: Every surgeon should be aware of the possibility of diverticulitis of the appendix in the operating room, even if this does not change the operative management. As diverticula of the cecum can be found as solitary lesions, as multiple lesions confined to the right colon, or as part of a generalized disease of the entire colon, postoperative barium enema examination may be useful.     

Acute appendicitis of the appendiceal stump

We report a case of a 27-year-old man, status post open appendectomy as an infant, in whom the diagnosis of acute appendicitis of the appendiceal stump was made by computed tomography (CT). A coronal reformatted CT image demonstrated both the inflamed appendix and a normal terminal ileum. Although rare, stump appendicitis may present with signs and symptoms typical of acute appendicitis in patients status post appendectomy and should be considered in the differential diagnosis.     

Appendicitis complicating pregnancy.

In this series, nine pregnant patients had appendectomy. Seven patients had acute appendicitis; pyuria and symptoms suggesting urinary tract infection delayed diagnosis in one whose appendix perforated. Abdominal pain and nausea with or without vomiting were presenting symptoms in all of the patients. Tenderness in the right lower quadrant was present in six. Eight patients, including two with a normal appendix, had leukocytosis with a left shift. There was no fetal or maternal loss. In addition, I reviewed more than 900 other cases of appendectomy during pregnancy, as reported in the literature since 1960. Among 713 previously reported cases of confirmed appendicitis, rupture had occurred in 25%. There were five maternal deaths, all in the group of patients with perforation. Perinatal mortality was 4.8% among patients with acute inflammation only and 19.4% in those with perforative appendicitis. The diagnosis rests on clinical acumen, and prompt surgical intervention is the key to good outcome.     

临床评分与超声检查评估儿童急性阑尾炎的价值

目的 探讨阑尾炎临床评分与超声检查的实用性及儿童阑尾切除术前超声检查的必要性.方法 将68例因“急性阑尾炎”行阑尾切除术的患儿分为超声检查组和直接手术组,回顾性分析其临床资料和超声结果,并与手术病理结果对照.计算临床评分与超声检查诊断阑尾炎的准确性、敏感性和特异性.计算超声判断阑尾穿孔与粪石的准确性、敏感性和特异性.结果 临床评分的总体准确率、敏感性及特异性分别为80.9％(55/68),83.1％(54/65),33.3％(1/3),超声检查的准确率、敏感性及特异性均为100％(56/56),两者差异有统计学意义(P=0.001);超声检查组与直接手术组的阑尾阴性切除率分别为1.8％(1/56)和16.7％(2/12);超声判断了阑尾穿孔,准确性、敏感性和特异性分别为81.8％(45/55)、85.7％(24/28)、88.8％(24/27).超声判断阑尾粪石的准确性,敏感性、特异性分别为74.5％(41/55)、69.7％(23/33)、81.8％(18/22).结论 超声检查能够发现易被临床评分漏诊的不典型阑尾炎,有效降低阑尾阴性切除率,同时在判断阑尾穿孔与阑尾粪石上有一定价值.     

Diagnostic accuracy of laboratory and ultrasound findings in patients with a non-visualized appendix

Ultrasound (US) and laboratory testing are initial diagnostic tests for acute appendicitis. A diagnostic dilemma develops when the appendix is not visualized on US. Objective: To determine if specific US findings and/or laboratory results predict acute appendicitis when the appendix is not visualized. Methods: A prospective study was conducted on children (birth-18?yrs) presenting to the pediatric emergency department with suspected acute appendicitis who underwent right lower quadrant US.Children with previous appendectomy, US at another facility, or eloped were excluded. US findings analyzed: inflammatory changes, right lower quadrant and lower abdominal fluid, tenderness during US exam and lymph nodes. Diagnoses were confirmed via surgical pathology. Results 1252 subjects were enrolled, 60.8% (762) had appendix visualized and 39.1% (490) did not. In children where the appendix was not seen, 6.7% [33] were diagnosed with appendicitis. Among patients with a non-visualized appendix, the likelihood of appendicitis was significantly greater if: inflammatory changes in the RLQ (OR 18.0, 95% CI 4.5–72.1), CRP >0.5?mg/dL (OR 2.64, 95% CI 1.0–6.8), or WBC?>?10 (OR 4.36, 95% CI 1.66–11.58). Duration of abdominal pain >3?days was significantly less likely associated with appendicitis in this model (OR 0.34, 95% CI 0.003–0.395). Combined, the absence inflammatory changes, CRP?<?0.5?mg/dL, WBC?<?10, and pain, ≤3?days had a NPV of 94.0%. Conclusion When the appendix is not visualized on US, predictors for appendicitis include the presence of inflammatory changes in the RLQ, an elevated WBC/CRP and abdominal pain <3?days.