Quillin S P, Siegel M J
Mallinckrodt Institute of Radiology, St. Louis, MO 63110-1076, USA.
AJR Am J Roentgenol. 1995 May;164(5):1251-4. doi: 10.2214/ajr.164.5.7717241.
We performed color Doppler imaging of the right lower quadrant in children with acute appendicitis to characterize the imaging findings indicative of appendiceal perforation and to determine the value of this technique in diagnosing appendiceal abscesses.
Forty-seven children with surgically proven appendicitis underwent color Doppler sonography of the right lower quadrant as an adjunct to gray-scale sonography. At pathologic examination, 27 patients had nonperforating appendicitis and 20 patients had perforating appendicitis. In the latter group, seven patients had abscesses and 10 had phlegmon. The color Doppler sonograms were evaluated for the presence or absence of appendiceal hyperemia, hyperemic periappendiceal or pelvic fluid collections, and hyperemic soft tissues in the right lower quadrant.
Color Doppler sonography showed appendiceal hyperemia in 21 (78%) of the 27 patients with nonperforating appendicitis and in eight (40%) of the 20 patients with perforating appendicitis. The hyperemia was scattered in 14 (67%) of the 21 patients without perforation and in six (75%) of the eight patients with perforation. The remaining patients with blood flow identifiable on color Doppler sonography had focal appendiceal hyperemia. For seven (35%) of the 20 patients with perforating appendicitis, color Doppler examination showed hyperemic, loculated periappendiceal or pelvic fluid collections, subsequently proved to be abscesses at surgery. No patient with nonperforating appendicitis had a hyperemic, loculated periappendiceal or pelvic fluid collection. Ten patients with perforating appendicitis displayed increased color Doppler signal in the adjacent right-lower-quadrant bowel loops and soft tissues, indicating phlegmon or peritonitis.
Our results indicate that the best color Doppler sonographic predictors of appendiceal perforation are a hyperemic periappendiceal or pelvic fluid collection and periappendiceal soft-tissue hyperemia. A hyperemic, loculated fluid collection appears specific for the diagnosis of abscess.
我们对患有急性阑尾炎的儿童右下象限进行彩色多普勒成像，以描述提示阑尾穿孔的影像学表现，并确定该技术在诊断阑尾脓肿中的价值。
47例经手术证实患有阑尾炎的儿童接受了右下象限彩色多普勒超声检查，作为灰阶超声检查的辅助手段。病理检查显示，27例患者为非穿孔性阑尾炎，20例患者为穿孔性阑尾炎。在后一组中，7例患者有脓肿，10例患者有蜂窝织炎。对彩色多普勒超声图像进行评估，观察是否存在阑尾充血、阑尾周围或盆腔充血性液体积聚以及右下象限充血性软组织。
彩色多普勒超声显示，27例非穿孔性阑尾炎患者中有21例（78%）阑尾充血，20例穿孔性阑尾炎患者中有8例（4%）阑尾充血。在21例未穿孔患者中，14例（67%）充血为散在性，在8例穿孔患者中，6例（75%）充血为散在性。彩色多普勒超声上可识别血流的其余患者有局限性阑尾充血。20例穿孔性阑尾炎患者中有7例（35%）彩色多普勒检查显示阑尾周围或盆腔有充血性、局限性液体积聚，随后手术证实为脓肿。非穿孔性阑尾炎患者均无阑尾周围或盆腔充血性、局限性液体积聚。10例穿孔性阑尾炎患者在相邻的右下象限肠袢和软组织中显示彩色多普勒信号增强，提示蜂窝织炎或腹膜炎。
我们的结果表明，阑尾穿孔的最佳彩色多普勒超声预测指标是阑尾周围或盆腔充血性液体积聚以及阑尾周围软组织充血。充血性、局限性液体积聚似乎对脓肿的诊断具有特异性。
