WONCA Online电子病例介绍——盲肠扭转

·一般情况:患者,女,46岁,因右上腹疼痛并向背部、侧胸部放射就诊,有恶心、呕吐2次.2周前行腹腔镜胆囊切除术,手术顺利无并发症,术后饮食正常.腹部疼痛时不伴有腹泻、腹胀等,无发热、寒战.既往有高血压、高胆固醇血症及胆囊病史,无吸烟及饮酒嗜好.     

Radiologic findings in tsunami trauma: experience with 225 patients injured in the 2004 tsunami

The objective of this study was to determine the spectrum of radiographic findings, frequency, and type of injuries in tsunami victims. From December 2004 to May 2005, all tsunami victims admitted to our hospital were retrospectively identified by a search of medical records. Patients who received radiologic examinations were reviewed for their radiographic findings. The authors identified 225 tsunami victims. One hundred eight victims received radiologic evaluations on admission that included 350 plain radiographs, 19 ultrasound exams, 18 computed tomography (CT) scans and 3 magnetic resonance imaging (MRI) scans. Overall positivity rate was 48% (187/390). Most common trauma involved musculoskeleton (102/187, 54.5%). Retained foreign bodies in soft tissues, pneumonia/aspiration, and tsunami sinusitis were found in 22, 28, and 31 patients (9.8, 12.4, and 13.8%), respectively. These were unique findings in tsunami trauma. Imaging played an important role in detection of these abnormalities.     

Multidetector-row computed tomography of thoracic trauma

Imaging in trauma patients has dramatically evolved since the advent of computed tomography (CT), particularly multidetector CT (MDCT) technology. Axial MDCT images of the body can be acquired in seconds and shown any plane, allowing immediate viewing and interpreting. These factors make CT an invaluable means to detect many injuries not previously visible by any other noninvasive imaging techniques. Potentially subtle, but significant, thoracic injuries such as pneumothorax, haemothorax, aortic injury, sternal and spinal fractures can be detected on MDCT easily. In this article, the author will discuss the use of MDCT in the diagnosis of various thoracic injuries.     

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.     

False-Negative Appendicitis at Ultrasound: Nature and Association

The objective was to describe nature and factors associated with false-negative ultrasound (US) for adult appendicitis. Patients with pathologically proven appendicitis and pre-operative US from January 2011 to May 2013 were included in this retrospective case-control study. They were divided into true-positive and false-negative groups, matched by age and gender. There were 112 patients (40 men, mean age = 40 y, 56 true positives) included. Two factors were found differ significantly: abdominal wall thickness and pain score. Greater abdominal wall thickness (18.6 mm vs. 14.9 mm, p = 0.001) and lower pain score (6.6 vs. 7.5, p = 0.018) were statistically associated with false negativity. The two groups did not differ significantly in terms of weight, height, body mass index, symptom duration, Alvarado score, US examination time, appendix position/size, perforation rate and operator. In conclusion, lower pain score and increased abdominal wall thickness are associated with false negativity in US examinations.