CT of Acute Appendicitis: Typical and Atypical Presentations

自民國79年10月至83年1月止，我們共收集了39個經手術及病理證實為急性闌尾炎的病例，回溯性地觀察其電腦斷層影像，發現電腦斷層能偵測出所有病例的腹內病灶，且在32個病例(82%)，能正確地推斷出闌尾炎的診斷。在此39個病例中，有26個病人(67%)可發現其發炎的闌尾；8個病人(21%)可見其鈣化的闌尾糞石；28個病人(72%)有濃瘍產生；腹內有腸外氣體者有18個病人(46%)。其他合併症諸如腸阻塞，則見於13個病人(33%)；合併上腸繫膜靜脈門脈炎者有5人(13%)。共有15個病人被判定為具有非典型電腦斷層表現。除了在腸外氣體以非典型者較常見以外，其他在膿瘍產生、腸阻塞、以及合併上腸繫膜靜脈門脈炎之發生比率，在典型與非典型的兩組病人中，並無明顯差異“在非典型病人中，最常見的，就是表現出不尋常部位的膿瘍淤積，而易被誤以為是其他部位之發炎反應；或是合併有軟組織腫塊，而易誤認為併有合併症之腫瘤。在這些病人中，有7個病人可發現在膀胱直腸凹間有大量的膿瘍潑積，而闌尾附近卻只有些許的發炎反應。在找不到闌尾或闌尾糞石的情形下，異常的膿瘍儲積在右骨盆腔或膀胱直腸凹間，雖不具特異性，仍應懷疑到急性闌尾炎合併闌尾穿孔的可能。

關鍵字

闌尾炎；闌尾；電腦斷層

並列摘要

From October '90 to January '94, the CT scans of 39 patients with surgically proved acute appendicitis were retrospectively collected. On the basis of the original interpretation, CT scans had established the presence of abdominal disease in all of the cases, making a specific diagnosis of appendicitis in 32 patients (82%). Among the 39 patients, a swelling appendix was detected in 26 (67%), calcified appendicoliths in 8 (21%), abscesses in 28 (72%) and extraluminal gas in 18 (46%). Associated complications such as intestinal obstruction were seen in 13 cases (33%), and pylephiebitis of superior mesenteric vein in 5 (13%). Of the 15 patients with atypical CT presentations, unusual abscess location and the associated soft tissue densities, which might be mistaken as intraabdominal inflammatory processes of different origins or complicated neoplasm, were the most striking features. Of these patients, a large abscess accumulation in the cul-de-sac, with little reaction in the periappendiceal fossa, were seen in seven patients. In the absence of visualized appendices or appendicoliths, abscesses loculation in the right pelvic cavity or cul-de-sac, although non-specific, should raise the suspicion of a possible perforated appendicitis.

並列關鍵字

Appendicits ； appendix ； computed tomography

國際替代計量

CT of Acute Appendicitis: Typical and Atypical Presentations

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