阑尾黏液性肿瘤CT误诊为卵巢源性占位病例分析

CT misdiagnosis of appendicitis mucinous tumor as ovariogenic mass case a nalysis

目的:分析误诊为卵巢源性占位的阑尾黏液性肿瘤的CT表现,并探讨误诊原因及防范措施。方法:回顾性分析2014年6月至2021年5月皖南医学院弋矶山医院收治的13例阑尾黏液性肿瘤CT误诊为卵巢源性占位的临床资料。结果:本组CT误诊率为31.7%,10例误诊为卵巢源性肿瘤,3例误诊为卵巢源性囊肿;3例妇科体检发现,1例因绝经后阴道流血,9例因腹胀、腹痛、自觉腹部包块就诊。CT示4例阑尾管状增粗、7例右下腹/盆腔类圆形或茄子状囊性灶,2例右下腹分叶状囊实性病灶;13例均见腹盆腔液性密度影,其中2例见网膜饼状增厚,1例肝脾周围扇贝样压迹。所有病例均经手术病理确诊,10例为低级别阑尾黏液性肿瘤、3例为阑尾黏液性腺癌。结论:影像科医生应加深对阑尾黏液性肿瘤影像表现、临床及生物学性质的认识,仔细寻找阑尾病变,必要时采用多平面重建、超声肠镜等手段辅助诊断,以降低术前误诊率。

Objective:To analyze the CT findings of appendicitis mucinous tumor misdiagnosed as ovariogenic space occupying,and to discuss the causes of misdiagnosis and preventive measures.Methods:The clinical data of 13 cases of appendicitis mucinous tumor misdiagnosed by CT as ovariogenic space occupying admitted to Yijishan Hospital of Wannan Medical College from June 2014 to May 2021 were retrospectively analyzed.Results:CT misdiagnosis rate was 31.7%,10 cases were misdiagnosed as oval-derived tumor,3 cases as oval-derived cyst.The results of gynecological physical examination of 3 cases showed that 1 case was due to postmenopausal vaginal bleeding and 9 cases were due to abdominal distension,abdominal pain and conscious abdominal mass.CT showed tubular thickening of the appendix in 4 cases,round or aubergine-like cystic lesions in the right lower abdomen/pelvic cavity in 7 cases,and lobular cystic solid lesions in the right lower abdomen in 2 cases.The fluid density shadow was observed in the abdomen and pelvic cavity in all the 13 cases,among which 2 cases had the omental cake thickening and 1 case had the scallop-like indentation around the liver and spleen.All cases were confirmed by operation and pathology,10 cases were low-grade appendiceal mucinous tumor and 3 cases were appendiceal mucinous adenocarcinoma.Conclusions:Radiologists should deepen their understanding of the imaging manifestations,clinical and biological properties of appendiceal mucinous tumors,carefully search for appendiceal lesions,and use multi-plane reconstruction and ultrasonic colonoscopy to assist diagnosis when necessary,so as to reduce the rate of preoperative misdiagnosis.