Radiology Department, CHU Lapeyronie, 371 Avenue du doyen Gaston Giraud, 34295 Montpellier, France.
Radiology Department, CHU Lapeyronie, 371 Avenue du doyen Gaston Giraud, 34295 Montpellier, France.
Eur J Radiol. 2020 Sep;130:109165. doi: 10.1016/j.ejrad.2020.109165. Epub 2020 Jul 8.
Acute appendicitis is one of the most common surgical emergencies worldwide. Over the past 30 years, imaging has become central to the diagnosis of appendicitis, reducing both negative appendicectomy rate and healthcare expenses. Appendicitis can be challenging in many ways for radiologists with various clinical presentations, complications and differential diagnoses. The aim of this review is to present a step-by-step reasoning with key findings, tips and tricks leading to the diagnosis of appendicitis and its complications. The first steps are with the use of the appropriate imaging modality (US, CT and MRI) to locate the appendix in abdominal cavity and to identify the features of appendicitis and its complications through specific imaging signs. The next steps are to eliminate an unusual morphology of the appendix that may simulate acute appendicitis and to recognize an unusual imaging presentation of appendicitis. Then, to corroborate the diagnosis of appendicitis, the last step is to rule out any differential diagnoses mainly from the genitourinary and gastrointestinal tracts. Following these steps can help to accurately diagnose appendicitis and its complications.
急性阑尾炎是全球最常见的外科急腹症之一。在过去的 30 年中，影像学已成为阑尾炎诊断的核心手段，降低了阴性阑尾切除术率和医疗费用。对于放射科医生来说，阑尾炎在很多方面都具有挑战性，因为它具有多种临床表现、并发症和鉴别诊断。本综述的目的是介绍一种逐步推理的方法，重点介绍导致阑尾炎及其并发症诊断的关键发现、技巧和窍门。第一步是使用适当的成像方式（US、CT 和 MRI）在腹腔中定位阑尾，并通过特定的影像学征象识别阑尾炎及其并发症的特征。接下来是排除可能模拟急性阑尾炎的阑尾异常形态，并识别阑尾炎的异常影像学表现。然后，为了证实阑尾炎的诊断，最后一步是排除主要来自泌尿生殖系统和胃肠道的任何鉴别诊断。遵循这些步骤可以帮助准确诊断阑尾炎及其并发症。
