Almerie Muhammad Qutayba, Culverwell Adam, Krishna Jyoti, Mahon Christopher
Department of General Surgery, Leeds University, St James's University Hospital, Leeds, UK.
Department of Radiology, Harrogate District Hospital, Harrogate, UK.
BMJ Case Rep. 2016 Feb 25;2016:bcr2015213911. doi: 10.1136/bcr-2015-213911.
Advanced radiological imaging has largely replaced exploratory operations and has become an essential diagnostic tool clinicians routinely rely on. However, physicians are faced with a lot of radiological findings without histological proof, and assuming a more serious diagnosis may lead to unnecessary investigations and emotional stress for patients. We report an unusual presentation of chronic appendicitis with a synchronous peritoneal nodule on CT in a 76-year-old woman who presented with poor appetite, weight loss and a mass in the right iliac fossa. The coincidental finding of the nodule in addition to the suspicious appearance of the appendix raised concerns for primary appendiceal cancer with peritoneal metastasis. The case illustrates the patient's management and reflects on the learnt lessons with regard to careful use of invasive radiology-guided biopsies and interval imaging, as these could sometimes delay the diagnosis and management of a readily treatable disease.
先进的放射影像学在很大程度上已取代了探查性手术，并已成为临床医生日常依赖的重要诊断工具。然而，医生面临着许多没有组织学证据的放射学检查结果，而假设诊断更为严重可能会导致患者进行不必要的检查和产生情绪压力。我们报告了一名76岁女性慢性阑尾炎的不寻常表现，其CT上同时出现腹膜结节，该患者表现为食欲减退、体重减轻以及右下腹肿块。除了阑尾的可疑表现外，结节的意外发现引发了对原发性阑尾癌伴腹膜转移的担忧。该病例阐述了患者的治疗过程，并反思了在谨慎使用侵入性放射学引导活检和间隔期影像学检查方面所吸取的教训，因为这些有时可能会延迟对易于治疗疾病的诊断和治疗。
