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Ultrasonography of Retroperitoneal Abscesses
後腹腔膿瘍之超音波掃描
摘要
後腹腔膿瘍(RA)之臨床症狀與表徵無特異牲，且傳統放射線學檢查提供之資訊有限，故以往RA之死亡率相當高。超音波掃描(US)可直接探查病灶，若應用得當，可用以早期發現病灶以降低死亡率。作者回顧25例經US和電腦斷層攝影(CT)檢查並經證實之RA，發現男性佔14例，女性11例，年齡分佈為6至75歲。罹病因素以腎盂腎炎；急性胰炎和感染性脊椎炎或關節炎佔最多，但仍有6例為原發性或原因不明。25例RA中，4例主要位於前腎旁腔，8例位於腎周腔，13例位於後腎旁腔。25例RA，有19例侵及腰肌或骼肌，此包括8例腎周腔膿瘍中的5例和4例胰膿瘍中的1例。兩側性的RA有3例。 所有RA之範圍及其周圍變化可以CT詳細呈示，以US偵測出RA之病例有19個，US對RA之靈敏性為76%。此19例膿瘍中，US呈現病灶為低回音性者有8例，複合回音性4例，高回音性2例，囊性並有散在性回音者2例；膿瘍因有氣泡而有極高回音性者3例。導致US假陰性之原因包括：(1)腸膈或腹部脂肪過多；(2)膿瘍過小或病灶與周圍組織為同回音性；(3)病灶係以氣泡表現，使US誤認為腹腔脂肪。有21例膿瘍之厚壁或筋膜之肥厚未能以US詳細呈顯。以CT顯示膿瘍中之異常氣體或中隔各有5例；其中能以US呈現的各有3例。 若要呈現病灶侵犯範圍，膿瘍周圍軟組織或骨骼變化和異常氣體，固然CT優於US，然而US為一無侵潤性，無游離輻射性，多向性及價廉之檢查，對一懷疑有RA之患者，US不虧為一第一線之診斷利器。在本報告中，RA之死亡率為8%，遠比國外報告的低，這主要應歸功於US能夠早期發現病變，並予以適當的治療。
並列摘要
Twenty-five patients with verified retroperitoneal abscesses (RA) underwent both ultrasonography (US) and computed tomography (CT). The most common predisposing factors were pyelonephritis, acute pancreatitis and infectious spondylitis or sacroiliitis. The cause was unknown in 6 cases. The RA was primarily located in the anterior pararenal space in 5 cases, in the perirenal space in 8, and in the posterior pararenal space and the muscles in 12. Psoas or iliac muscles were involved in 19 cases, including 5 out of 8 cases of perirenal abscesses, and 1 out of 4 cases of pancreatic abscesses. Bilateral RA were encountered in 3 patients. US detected the lesions in 19 (76%) of the 25 cases. The detected abscesses on sonograms appeared hypoechoic (8 cases), complex (4), hyperechoic (2), cystic with internal echoes (2), or as lesions with strongly hyperechoic spots due to gas (3). The causes of 6 false negatives included obscuration of the lesions by ileus or copious fat, smaller size of the lesions, or RA with only minimal gas-content. The gas- collection within the abscesses, which was observed on CT images in 5 cases, was detected by US in 3. It is concluded that US is a good primary screening modality for patients with suspected RA. In this report, the low mortality rate of RA, 8%, is attributed to the early detection by US.
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