紗布存留引起腹腔內膿瘍之超音波表現

Sonographic Appearance of Intraabdominal Abscesses Induced by Gauze Retention

盧志雄(C. H. Lu) ； 周宜宏(Y. H. Chou) ； 許重權(C. C. Hsu) ； 吳峻吉(C. C. Wu) ； 張遵(T. Chang)

《中華放射線醫學雜誌》 9卷2期 (1984/06) Pp. 150-156

摘要

腹腔內發生膿瘍因其部位以及超音波影像的表現互異，在國內外均有許多報告文獻發表，然因紗布存留於腹腔中而致膿瘍之發生，國內外均屬罕見，榮民總醫院近兩年多（69年10月至71年1月）經手術證實了四例這類病人，其中兩例形成巨大的膿瘍，另兩例引起嚴重的局部炎性反應而未形成明顯之空間佔據性膿瘍，這四例病人均接受灰白調超音波掃描檢查(grey scale ultrasonic examination)，前兩例超音波影像顯示為－巨大薄壁囊狀病灶(thin-walled cystic lesion)，內含因重力而沈降於下部(dependent portion)高強度不規則內在回音(strong irregular internal echoes)，其前後壁大體而言規則而明顯(sharp)，後兩例則出現高強度連續性水平走向之線性回音(strong continuous linear reflection)，其中一例伴有音波陰影(acoustic shadowing)，即所謂的殼徵象(shell sign)。其中前兩例病人並經電腦斷層攝影檢查(CT Scanning)，並未在囊狀病灶中確實偵測到紗布存在，但CT在對超音波影像上因何物產生高強度內在回音的解釋，在鑑別診斷上可排除一些腫瘤的可能性，因此可視為－輔助性之檢查，最後配合病人曾有腹部手術的病史，更應想到紗布存留的可能性。

並列摘要

Different ultrasonographic appearances of intraabdominal abscesses have been reported in the world literatures, but only few reports mentioned about the abscesses induced by retention of gauze. We encountered four cases of surgically proved intraabdominal abscesses secondary to gauze retention in recent two years at Veterans General Hospital, Taipei. Two of them had huge solitary abscesses noted on surgery, the other two showed marked regional inflammatory reaction with minimal abscess formations. The former two showed a sonographic picture of a large thin-walled cystic lesion with strong irregular internal echoes in the dependent portion associated with even or minimal uneven inner walls. The later two presented as strong continuous horizontal linear reflection, one of these cast apparent acoustic shadows and produced the so called ”shell sign”. All the four cases were examined by Rohnar 5580 (Rohe) static ultrasound scanner. Two of four cases had been examined with computed tomography (CT). CT adds little information but may be helpful in differential diagnosis.