Department of Diagnostic Imaging, The Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Clin Radiol. 2011 Nov;66(11):1030-5. doi: 10.1016/j.crad.2011.05.005. Epub 2011 Jun 29.
To determine CT features that can potentially differentiate right tubo-ovarian abscess (TOA) from acute appendicitis (AA; including abscess formation).
The abdominal computed tomography (CT) images of 48 patients with right-sided TOA (average age 39.3 ± 9.8 years) and 80 patients (average age 53.5 ± 19.9 years) with AA (24 with peri-appendicular abscess) were retrospectively evaluated. Two experienced radiologists evaluated 12 CT signs (including enlarged, thickened wall ovary, appendix diameter and wall thickness, peri-appendicular fluid collection, adjacent bowel wall thickening, fat stranding, free fluid, and extraluminal gas) in consensus to categorize the studies as either TOA or AA. The diagnosis and the frequency of each of the signs were correlated with the surgical and clinical outcome.
Reviewers classified 92% cases correctly (TOA=85%, AA=96.3%), 3% incorrectly (TOA=6.3%, AA=1.3%); 5% were equivocal (TOA=8.3%, AA=2.5%). In the peri-appendicular abscess group reviewers were correct in 100%. Frequent findings in the TOA group were an abnormal ovary (87.5%), peri-ovarian fat stranding (58.3%), and recto-sigmoid wall thickening (37.5%). An abnormal appendix was observed in 2% of TOA patients. Frequent findings in the AA group were a thickened wall (32.5%) and distended (80%) appendix. Recto-sigmoid wall thickening was less frequent in AA (12.5%). The appendix was not identified in 45.8% of the TOA patients compared to 15% AA.
In the presence of a right lower quadrant inflammatory mass, peri-ovarian fat stranding, thickened recto-sigmoid wall, and a normal appearing caecum, in young patients favour the diagnosis of TOA. An unidentified appendix does not contribute to the differentiation between TOA and peri-appendicular abscess.
确定 CT 特征，这些特征可能有助于将右侧输卵管卵巢脓肿（TOA）与急性阑尾炎（AA；包括脓肿形成）区分开来。
回顾性分析了 48 例右侧 TOA（平均年龄 39.3±9.8 岁）和 80 例 AA 患者（平均年龄 53.5±19.9 岁，其中 24 例伴有阑尾周围脓肿）的腹部 CT 图像。两名经验丰富的放射科医生评估了 12 项 CT 征象（包括增大、增厚的卵巢壁、阑尾直径和壁厚度、阑尾周围积液、邻近肠壁增厚、脂肪条纹、游离液体和腔外气体），并将这些研究归类为 TOA 或 AA。将诊断和每种征象的频率与手术和临床结果相关联。
两名观察者正确分类了 92%的病例（TOA=85%，AA=96.3%），错误分类了 3%的病例（TOA=6.3%，AA=1.3%），5%的病例分类不确定（TOA=8.3%，AA=2.5%）。在阑尾周围脓肿组中，观察者的分类均正确。在 TOA 组中，常见的表现为异常卵巢（87.5%）、卵巢周围脂肪条纹（58.3%）和直肠乙状结肠壁增厚（37.5%）。TOA 患者中有 2%出现异常阑尾。在 AA 组中，常见的表现为增厚的阑尾壁（32.5%）和扩张的阑尾（80%）。直肠乙状结肠壁增厚在 AA 中不常见（12.5%）。与 15%的 AA 相比，TOA 患者中 45.8%的阑尾无法识别。
在右下象限炎症性肿块、卵巢周围脂肪条纹、增厚的直肠乙状结肠壁和正常外观的盲肠存在的情况下，年轻患者的诊断倾向于 TOA。无法识别阑尾并不能有助于区分 TOA 和阑尾周围脓肿。
