Jabra A A, Shalaby-Rana E I, Fishman E K
Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
J Comput Assist Tomogr. 1997 Jul-Aug;21(4):661-6. doi: 10.1097/00004728-199707000-00028.
Our goal was to review the CT findings and to help define the role of CT in the evaluation of appendicitis in children.
Of 730 children with surgically proven appendicitis, 22 underwent preoperative CT evaluation. Their CT scans and operative and pathology records were retrospectively reviewed. The CT scans were evaluated for appendiceal wall thickness, diameter, and location, appendicoliths, pericecal inflammation, phlegmon, abscess, free fluid, small bowel dilatation, and bowel wall thickening. Criteria for diagnosing appendicitis were (a) appendiceal wall thickening (> 1 mm) or (b) presence of abscess, phlegmon, or pericecal inflammation associated with appendicolith(s). Prospective reports of ultrasound examinations performed within 2 days of the CT scans were available in 14 children and were correlated with the CT findings.
An abnormally thickened appendix, with a diameter ranging from 9 to 18 mm, was seen in four children. Three appendices were retrocecal and one was near the cecal tip, anterior to the iliac vessels. Appendicoliths were present in 10 children, multiple in 1. Abscesses were seen in 13 of 22 children, multiple in 5. Phlegmon was seen in five children and pericecal inflammation in two. Bowel wall thickening was present in seven children and small bowel dilatation was noted in six. Other findings included free fluid, hydronephrosis, thickening of urinary bladder wall, air in the uterus and vagina, adenopathy, and thickening of the abdominal wall musculature. CT was diagnostic of appendicitis in 11 of 22 children (50%). In 14 children with both ultrasound and CT studies, CT was slightly better in diagnosing appendicitis and visualizing the abnormal appendix and was superior in defining the presence and extent of abscess and inflammation in 9 of 14 children.
CT is a useful adjunct in diagnosing appendicitis in children, with a major role in cases of complicated appendicitis.
我们的目标是回顾CT表现，并帮助确定CT在儿童阑尾炎评估中的作用。
在730例经手术证实为阑尾炎的儿童中，22例接受了术前CT评估。对他们的CT扫描以及手术和病理记录进行回顾性分析。评估CT扫描的阑尾壁厚度、直径、位置、阑尾结石、盲肠周围炎症、蜂窝织炎、脓肿、游离液体、小肠扩张和肠壁增厚情况。阑尾炎的诊断标准为：(a)阑尾壁增厚(>1mm)或(b)存在与阑尾结石相关的脓肿、蜂窝织炎或盲肠周围炎症。14例儿童在CT扫描后2天内进行了超声检查的前瞻性报告，将其与CT表现进行了对比。
4例儿童可见阑尾异常增厚，直径为9至18mm。3例阑尾位于盲肠后，1例位于盲肠尖端附近、髂血管前方。10例儿童存在阑尾结石，其中1例为多发。22例儿童中有13例可见脓肿，其中5例为多发。5例儿童可见蜂窝织炎，2例可见盲肠周围炎症。7例儿童存在肠壁增厚，6例可见小肠扩张。其他表现包括游离液体、肾积水、膀胱壁增厚、子宫和阴道内气体、淋巴结肿大以及腹壁肌肉增厚。22例儿童中有11例(50%)CT诊断为阑尾炎。在14例同时进行超声和CT检查的儿童中，CT在诊断阑尾炎和显示异常阑尾方面略胜一筹，在14例儿童中有9例在确定脓肿和炎症的存在及范围方面更具优势。
CT是诊断儿童阑尾炎的有用辅助手段，在复杂性阑尾炎病例中起主要作用。
