Rubens Deborah J
Department of Radiology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642-8648, USA.
Radiol Clin North Am. 2004 Mar;42(2):257-78. doi: 10.1016/j.rcl.2003.12.004.
In summary, US is the initial imaging modality for the evaluation of acute right upper quadrant pain. It permits accurate diagnosis of acute cholecystitis and successfully identifies multiple other causes of patient symptomatology. Some of these processes lie outside the hepatobiliary system and include renal infection and obstruction, pancreatitis and its sequelae, duodenal or colonic perforation or mass lesions, peritoneal tumor spread, adrenal hemorrhage, and even remote problems, such as pneumonia. The limitations on US include incomplete imaging of the liver, most often at the dome or beneath ribs on the surface, and incomplete visualization of lesion boundaries, particularly with some infections and tumors. For these clinical scenarios, contrast-enhanced CT is complementary to US and should be encouraged. In the biliary tree, US has limitations in situations in which the ducts are not dilated and sometimes with imaging the extra hepaticducts, especially distally. For these patients, CT or MR imaging (MRCP) is especially useful. If one keeps the clinical scenario in mind and always images a patient where he or she hurts, US is a powerful and effective diagnostic method for evaluating acute right upper quadrant pain.
总之，超声是评估急性右上腹疼痛的初始影像学检查方法。它能够准确诊断急性胆囊炎，并成功识别出导致患者症状的多种其他病因。其中一些病因位于肝胆系统之外，包括肾脏感染和梗阻、胰腺炎及其后遗症、十二指肠或结肠穿孔或肿块病变、腹膜肿瘤播散、肾上腺出血，甚至还有诸如肺炎等远处问题。超声的局限性包括对肝脏成像不完整，最常见于肝顶或肋骨表面下方，以及对病变边界的显示不完整，特别是对于某些感染和肿瘤。对于这些临床情况，对比增强CT是超声的补充检查，应予以推荐。在胆管系统中，当胆管未扩张时，超声存在局限性，有时在对肝外胆管成像时，尤其是在远端，也存在局限性。对于这些患者，CT或磁共振成像（MRCP）特别有用。如果牢记临床情况，并始终对患者疼痛部位进行成像检查，超声是评估急性右上腹疼痛的一种强大而有效的诊断方法。
