Retrocecal appendicitis presenting with air in the subhepatic space.

Two cases of perforated retrocecal appendicitis presenting with the roentgen finding of an air containing subhepatic abscess are discussed. Although it is an unusual cause for air in the right subhepatic space, retrocecal appendicitis should be considered in the radiologist's differential diagnosis.     

Beyond acute appendicitis: imaging and pathologic spectrum of appendiceal pathology

While acute appendicitis is a common and important clinical problem, a variety of other disease processes can affect the appendix. Simple and perforated appendicitis, tip appendicitis, and stump appendicitis share a common clinical presentation including anorexia, right lower quadrant pain, and fever. By imaging, most cases of acute appendicitis exhibit luminal dilation, wall thickening, and periappendiceal inflammatory stranding. In tip appendicitis, these changes are isolated to the distal appendix, often with an obstructing appendicolith. Perforated appendicitis can exhibit mural discontinuity, periappendiceal abscess, and/or extraluminal appendicoliths. After appendectomy, the appendiceal remnant or “stump” can become inflamed, often necessitating repeat surgery. Inflammatory bowel disease can involve the terminal ileum, secondarily involving the appendix, or may primarily involve the appendix. Patient symptoms can be chronic in such cases, and mucosal hyperenhancement is a pronounced imaging feature. In asymptomatic patients without appendiceal inflammation, the appendix can be dilated by intraluminal material such as inspissated succus in cystic fibrosis or mucus from benign appendiceal mucocele. Finally, neoplasms such as typical appendiceal carcinoid tumor and mucinous adenocarcinoma can involve the appendix. Carcinoids are often small and incidentally discovered at pathologic examination, while malignant mucinous adenocarcinoma tends to present with advanced disease including pseudomyxoma peritonei. Cecal cancers can also obstruct the appendiceal lumen and cause acute appendicitis; an astute radiologist can recognize this prospectively and facilitate definitive resection (right hemicolectomy) at the time of surgery. Attention to mural features, cecal configuration, and periappendiceal inflammation is essential to the correct prospective diagnosis of complicated appendicitis and less common appendiceal pathologies.     

Value of US in excluding acute appendicitis

A positive US finding can prevent further delay of the diagnosis of acute appendicitis (AA), but what is the value of a negative test? A US examination of the whole abdomen was performed in 279 patients clinically suspected of having appendicitis. In 86 of the 279 patients who had no evidence of appendicitis sonographicallym we tried to exclude appendicitis by an added effort to find the normal appendix or a condition mimicking AA. Of these 86 patients, 44 had another disease confirmed sonographically. The normal appendix was visible in 53 cases. Using the combination of these signs appendicitis could be excluded in 66 cases (76%). None of the ultrasonographically visualised normal appendices proved to be inflamed surgically. In 5 cases differential pathology coexisted with appendicitis. The best way of excluding AA is the visualisation of the normal appendix in its whole length, which was possible with forced search in 62% of cases.     

CT对不典型阑尾炎的诊断价值

目的探讨CT对症状不典型急性阑尾炎的诊断价值。方法收集临床首诊未考虑阑尾炎,而经手术和病理证实的阑尾炎病例23例,对其CT表现进行观察分析。结果有11例表现为阑尾增粗,肠壁增厚;2例表现为右下腹脓肿;2例盲肠周围可见少量游离气体影;3例女性患者表现为盆腔脓肿;4例表现为盲肠及回肠肠壁增厚,周围渗液;1例伴有小肠梗阻。其中6例阑尾内可见结石。结论 CT能清楚显示阑尾的位置、形态以及周围组织的关系,对不典型阑尾炎的临床诊断,具有较高价值。     

小儿单纯性阑尾炎的超声诊断

目的探讨超声探头触诊结合超声图像诊断小儿单纯性阑尾炎的价值。方法利用三层触诊法和对比法对32例经病理证实的小儿单纯性阑尾炎和13例健康小儿对照组进行超声检查,观察并分析超声图像特征。结果健康对照组13例三层触诊和对比法未见异常,超声图像腹膜后可见增大的淋巴结,体积较小。32例小儿阑尾炎中典型阑尾炎声像图21例,深压痛28例,中层压痛18例,抵抗压痛处26例,肌紧张3例,患儿抵抗压痛处26例。结论超声探头触压痛结合超声图像能有效提高小儿阑尾炎的早期诊断准确率。     

影像学在典型及非典型急性阑尾炎诊断中的临床价值

目的探讨影像学检查技术在诊断典型及非典型急性阑尾炎过程中的临床价值。方法回顾性分析经手术及病理证实的典型和非典型急性阑尾炎患者各20例的术前影像学检查的影像学表现。结果20例典型急性单纯性阑尾炎患者中,超声检查共诊断出17例,CT检查共诊断出18例;20例非典型急性化脓性阑尾炎患者中,超声检查共确诊14例,CT检查共确诊16例。结论对于临床症状不典型的急性阑尾炎患者,应及时准确地选择影像学检查技术以尽快诊断及治疗,而对于典型急性阑尾炎,不需要过度强调影像学检查确诊,以免延误手术时机,带来并发症。     

急性阑尾炎超声诊断的图像特征及临床价值

目的探讨超声在诊断急性阑尾炎中的图像特征及诊断价值。方法回顾性分析经临床手术证实的78例急性阑尾炎患者的超声资料。结果病理诊断单纯性阑尾炎23例，化脓性阑尾炎39例，坏疽性阑尾炎10例，阑尾周围脓肿6例。结论急性阑尾炎具有较典型的超声声像图特征，可为临床提供客观的诊断依据。     

超声检查在急性阑尾炎早期诊断中的价值

目的探讨超声检查在急性阑尾炎早期诊断中的价值。方法回顾性分析118例急性阑尾炎患者的临床资料。结果急性阑尾炎118例,超声诊断符合率92.4%;其中急性单纯性阑尾炎28例,诊断符合率85.7%;急性化脓性阑尾炎62例,诊断符合率96.7%;急性坏疽性阑尾炎16例,诊断符合率93.6%。混合包块型阑尾炎12例,诊断符合率83.3%。结论超声检查在急性阑尾炎的早期诊断中有较高的价值,结合病史、查体、动态观察及实验室检查可明显提高诊断率。     

Cecal apical changes with appendicitis: diagnosing appendicitis when the appendix is borderline abnormal or not seen

In most cases, CT of appendicitis shows a distended appendix with periappendiceal inflammation. A distended appendix, however, is not always visualized. In these patients, identifying changes at the anatomic cecal apex can secure a diagnosis of appendicitis. Cecal apical changes with appendicitis include focal cecal apical thickening, the arrowhead sign, and the cecal bar. This pictorial essay describes and illustrates the spectrum of CT appearances of cecal apical changes that can be seen with appendicitis.     

Magnetic resonance of acute appendicitis: pearls and pitfalls

Acute appendicitis is the most common surgical abdominal emergency. Although the clinical diagnosis can be made accurately in typical cases, imaging plays an important role in improving diagnostic accuracy of this condition, especially when the clinical diagnosis is uncertain. Magnetic resonance imaging is an emerging promising technique for the diagnosis of acute appendicitis, especially in patients with nondiagnostic ultrasound and in patients where radiation is a clinical concern. In the following review, the role of magnetic resonance in the diagnosis of appendicitis will be discussed.     

58例急性阑尾炎的超声图像分析

目的分析超声对急性阑尾炎的诊断价值及其声像特征。方法回顾性分析58例急性阑尾炎患术前超声诊断结果，并与术后病理进行对照。结果与术后病理对照，58例急性阑尾炎患中，术前超声检出54例，其中包括单纯性阑尾炎8例，化脓性阑尾炎26例，以及坏疽性阑尾炎20例，仅4例单纯性阑尾炎被漏诊。本组病人超声检出率为93．1％。结论超声对急性阑尾炎，尤其对已发展为化脓性或坏疽性阑尾炎，具有极高的诊断准确性，加之它的经济、方便，可作为诊断急性阑尾炎的首选方法。     

急性阑尾炎的超声诊断

目的探讨超声在急性阑尾炎诊断中的应用。方法回顾性分析经手术、病理证实的128例急性阑尾炎的超声图象。结果128例中正确诊断117例,诊断符合率为91．4％,误、诊4例,漏诊7例,误、漏诊率8．6％。结论超声应作为急性阑尾炎诊断和鉴别的常规检查。     

CT of appendicitis

The CT findings of 38 consecutive patients with acute appendicitis are analyzed, described, and illustrated. CT showed intraabdominal disease in 92% of patients and made a specific diagnosis of appendicitis in 79% of cases. The most common CT findings were pericecal inflammation (68%), abscess (55%), calcified appendicolith (23%), and an abnormal appendix (18%). CT had a sensitivity similar to that of contrast enema examinations, but it correlated much better with the surgical findings in detecting the precise nature, extent, and location of the disease process. Normal CT does not exclude appendicitis, since mild forms without periappendiceal disease may escape detection.     

Indium-111 leukocyte imaging in appendicitis

Indium-111-labeled leukocyte scintigraphy was applied to the diagnosis of acute appendicitis. Thirty-two patients observed in the hospital for possible appendicitis were prospectively studied. Scanning was done 2 hr after radiopharmaceutical injection. Thirteen scans were positive for acute appendicitis, and all but one were confirmed at laparotomy. In addition, two cases of colitis and two cases of peritonitis were detected. Of 15 negative studies, 11 had a benign course. Four patients with negative studies had laparotomy; two were found to have appendicitis and two had a normal appendix. Of 14 proven cases of appendicitis, 12 scans were positive for appendicitis with one false-positive scan, providing a sensitivity of 86%. Specificity was 93%: all negative cases except one had negative scans. Overall accuracy was 91% (29 of 32), comparing favorably with the accepted false-positive laparotomy rate of 25%. Use of In-111-labeled leukocyte scintigraphy serves to reduce the false-positive laparotomy rate and to shorten the clinical observation time in patients with acute appendicitis.     

螺旋CT对急性阑尾炎的诊断价值

目的：探讨螺旋CT对急性阑尾炎的诊断价值。方法：搜集CT提示或诊断为阑尾炎并经手术病理证实的34例患者，回顾性分析其CT征象。结果：15例CT表现为阑尾增粗，壁增厚；26例表现为右下腹或盆腔炎性改变（如周围脂肪密度增高、肠周积液、蜂窝织炎、脓肿、腔外气体、淋巴结肿大、相邻肠管增厚、阑尾结石或粪石）；6例盲肠末端有局限性增厚；4例右侧腰大肌影模糊。结论：CT诊断急性阑尾炎有独到之处，能为临床合理治疗提供帮助。     

Current concepts in imaging of appendicitis

Appendicitis is the most common cause of acute abdominal pain requiring surgery. Early diagnosis is crucial to the success of therapy. CT and ultrasound are widely recognized as very useful in the timely diagnosis of appendicitis. MR imaging is emerging as an alternative to CT in pregnant patients and in patients who have an allergy to iodinated contrast material. This article reviews the current imaging methods and diagnostic features of appendicitis.     

高低频超声结合在诊断急性阑尾炎中的临床价值

目的:探讨高频超声和低频超声联合应用在诊断急性阑尾炎中的临床价值。方法:对2008年5月～2010年5月我院临床怀疑急性阑尾炎者先行低频超声扫查,然后联合应用高频超声对比扫查。对123例术后病理证实为急性阑尾炎的超声图像进行回顾性分析。结果:低频超声诊出阑尾炎88例,符合率71.5%,低频超声联合高频超声诊出阑尾炎109例,符合率88.6%。阑尾长轴切面呈腊肠样盲端结构,短轴切面呈"同心圆"征。结论:高、低频超声联合应用能有效提高急性阑尾炎的超声诊断符合率,为临床治疗方案的判定提供重要的参考依据,在诊断急性阑尾炎中有重要的临床意义。     

High-resolution sonography of acute appendicitis

During a 7-month period high-resolution sonography was used in the evaluation of 68 patients with an equivocal clinical diagnosis of acute appendicitis. The sonographic findings were correlated with surgical-pathologic outcome in 32 cases and with clinical follow-up in the remainder. This technique was found to be accurate in the diagnosis of acute appendicitis with a specificity of 95%, a sensitivity of 80%, and an accuracy of 90%. The predictive value of a positive test was 91%; that of a negative test was 89%. The results show that high-resolution sonography is indicated to establish the diagnosis of acute appendicitis in patients with equivocal clinical findings.     

CT对急性阑尾炎的诊断价值

目的 评价CT扫描对急性阑尾炎的诊断价值：方法对临床怀疑急性阑尾炎患者48例均做CT平扫，层厚10mm、间距10mm，扫描范围从腰3椎体至耻骨联合。CT诊断急性阑尾炎的标准包括阑尾增粗横径超过6mm，阑尾结石伴阑尾周围炎性改变；CT诊断结果与手术病理结果进行对照。结果CT检查发现29例真阳性，15例真阴性，3例假阴性和1例假阳性。CT诊断急性阑尾炎的敏感性为90％，特异性为96％，准确性为9l％，阳性预测值93％，阴眭预测值为83％。15例无阑尾炎患者、CT发现其他病变11例（73％）。结论CT对急性阑尾炎诊断具有高度的敏感性、特异性和准确性。对真阴性患者可发现其他各种病变。     

多排螺旋CT在不典型急性阑尾炎诊断中的应用

目的探讨多排螺旋CT在不典型急性阑尾炎诊断中的意义。方法对56例不典型急性阑尾炎患者CT影像、治疗结果进行回顾性分析。结果 56例中,男20例,女36例,年龄17～88岁,平均(51.5±15.7)岁。发病时间1 h～7 d。螺旋CT均显示阑尾图像。CT影像表现为阑尾水肿增粗、管壁增厚33例,其中23例伴有阑尾周围渗出、积液。9例阑尾周围脓肿,5例阑尾腔内发现肠石。15例发现回盲部肠壁增厚,2例发现升结肠肿物。5例显示正常阑尾影像,其中2例发现右附件肿物,2例小肠节段性肠壁增厚,1例肠系膜淋巴结肿大。CT扫描结合临床诊断急性阑尾炎51例,行手术治疗47例,均经病理组织学检查证实。5例排除阑尾炎。结论多排螺旋CT阑尾影像特征对不典型急性阑尾炎诊断和治疗选择有重要价值。