急性阑尾炎的CT诊断

CT FINDINGS IN ACUTE APPENDICITIS

目的研究急性阑尾炎的典型CT表现。方法收集45例经手术病理证实的急性阑尾炎病例,回顾性分析其表现特征。结果 45例中CT诊断为急性阑尾炎可能1例(2.22%);急性阑尾炎8例(17.78%);急性阑尾炎并阑尾周围炎14例(31.11%);急性阑尾炎并穿孔5例(11.11%);阑尾脓肿13例(28.89%);阑尾炎性肿块4例(8.89%)。急性阑尾炎的CT直接征象为阑尾肿大增粗(直径>6mm)、阑尾壁增厚和阑尾石,间接征象有阑尾-盲肠周围脂肪内条索影等。临床诊断为急性阑尾炎可能4例;急性阑尾炎21例;阑尾炎包块16例;另有4例因右上腹痛而拟诊胆囊炎。主要CT表现:1阑尾肿胀,管壁增厚,可呈不同密度分层的"同心圆"样结构;阑尾边缘模糊,密度近似甚至高于邻近肌肉;2阑尾管腔内可见积液、粪石和气体;3阑尾系膜肿胀,周围脂肪组织密度升高;4阑尾穿孔,周围形成脓肿;5相邻盲肠壁可有增厚,末端呈尖角样改变;右侧肾筋膜和侧锥筋膜增厚;6小肠低位梗阻、肝脓肿等并发症。CT所显示的阑尾形态及其周围组织的改变,与手术和病理所见一致。结论急性阑尾炎有典型CT表现。CT检查可准确显示阑尾本身和周围组织改变及其合并症,为临床的诊治提供有价值的信息。CT对急性阑尾炎的诊断特别是对临床表现不甚典型的阑尾炎及其并发症的诊断,具有很高准确率。

Objective To investigate CT characteristics of acute appendicitis and to find the significance of CT findings in acute appendicitis.Methods A total of of 45 patients with acute appendicitis confirmed by CT were included in this study,in which21 male patients and 24 female patients were included and the average age was 48 years old with the range from38 y to 65 y.The clinical and CT data were analyzed retrospectively.Results Of 45 cases,acute appendicitis in9 cases;acute appendicitis accompanied with periappendicitis in14,acute appendicitis accompanied with perforation in5,appendiceal abscess in13 and inflammatory mass in 4,were diagnosed by CT.The direct features of acute appendicitis were enlarged appendix（〉6mm）,thickened wall and appendicolith.And indirect features included clouding or stranding of the pereiappendiceal fat,and et al.2 cases were misdiagnosed,accounting for 4.44%（2/45）.Conclusion The accuracy of CT in diagnosing acute appendicitis is very high,which is favorable to diagnosis acute appendicitis for suspected patients and complication of acute appendicitis.