临床不典型阑尾炎的CT诊断

CT diagnosis of appendicitis with atypical clinical manifestations

目的 探讨CT扫描对临床不典型阑尾炎的诊断价值。方法 搜集临床症状和体征不典型,经手术和病理证实为阑尾炎者14例,回顾性分析其CT表现。 结果 13例具有阑尾炎的CT表现:5例阑尾增粗、壁增厚,其中2例阑尾内见结石,1例结石位于穿孔阑尾周围;盲肠周围炎8例,腰大肌前方脓肿2例,盲肠末端局限性增厚4例,右侧结肠旁沟及盆腔积液3例。另1例表现为右下腹脓肿因而误诊为盆腔炎。结论 临床症状和体征不典型的阑尾炎临床诊断困难,易造成误诊,多数病例根据其CT表现可做出正确诊断。

Purpose To explore CT value for the diagnosis of the atypical clinical manifestations. Methods To collect 14 cases with atypical clinical symptoms and signs but confirmed by surgery and pathology, reviewed their CT images of the abdomen retrospectively. Results The CT findings displayed as appendicitis in 13 cases: the appendix enlarged and the appendix wall thickened in 5 cases, including ap-pendicolith in 2 cases, calculus lying around the perforating appendix in 1 case; pericecal inflammation in 8 cases, abscess ahead of psoas major in 2 cases, local thickening of the end of cecum in 4 cases, fluid accumulating in the lacune neighboring the right colon and pelvis in 3 cases. The other 1 case displayed as abscess of the lower abdomen and was thus misdiagnosed as pelvic inflammation. Conclusion It is difficult to make the diagnosis of appendicitis with atypical clinical symptoms and signs, but in most cases, the correct diagnosis of appendicitis could be made by CT findings.