Morrison J C, Ramos-Gabatin A, Gelormini R G, Brown J W, Pitts N L
Department of Radiology, Wilford Hall USAF Medical Center, Lackland AFB, Texas 78236-5300.
J Nucl Med. 1993 Jul;34(7):1169-71.
An immunosuppressed, neutropenic patient developed symptoms and signs of acute cholecystitis. Gallbladder ultrasound was consistent with acute cholecystitis. Technetium-99m-diisopropyl iminodiacetic acid (DISIDA) scan showed a rim sign, but with normal gallbladder visualization. On restudy 72 hr later when the patient's WBC count was recovering, the 99mTc-DISIDA scan again showed a persistent rim sign, but now there was no gallbladder visualization at 1 hr, a pattern strongly predictive for acute complicated cholecystitis. Biliary drainage was performed by percutaneous cholecystotomy with clinical improvement. Semielective cholecystectomy performed 8 wk later confirmed both acute and chronic cholecystitis. We describe the rim sign and its variants, mechanisms of causation, prognostic importance and correlate our report with a review of the literature.
一名免疫抑制、中性粒细胞减少的患者出现了急性胆囊炎的症状和体征。胆囊超声检查结果与急性胆囊炎相符。锝-99m-二异丙基亚氨基二乙酸（DISIDA）扫描显示边缘征，但胆囊显影正常。72小时后复查，此时患者白细胞计数正在恢复，99mTc-DISIDA扫描再次显示持续的边缘征，但1小时时胆囊未显影，这种表现强烈提示急性复杂性胆囊炎。通过经皮胆囊造瘘术进行胆道引流后临床症状改善。8周后进行的半择期胆囊切除术证实存在急性和慢性胆囊炎。我们描述了边缘征及其变体、病因机制、预后重要性，并将我们的报告与文献综述进行了关联。
