Rao P M, Rhea J T, Novelline R A
Department of Radiology, Massachusetts General Hospital, Boston 02114, USA.
Radiology. 1997 Sep;204(3):709-12. doi: 10.1148/radiology.204.3.9280247.
To determine the appearance of appendicitis in the distal part of the organ (distal appendicitis) on computed tomographic (CT) scans and to evaluate the accuracy of diagnosis based on CT findings.
CT scans and medical records in 180 consecutive patients with proved appendicitis were reviewed. Fourteen had distal appendicitis with at least a 3-cm length of normal proximal appendix. Appendiceal CT scans and initial reports were reviewed retrospectively.
The proximal appendix was collapsed (n = 6) or was filled with contrast material (n = 6) or air (n = 2). Inflamed distal appendices averaged 13.2 mm in diameter and were associated with periappendiceal fat stranding (n = 14), adenopathy (n = 6), appendolith(s) (n = 4), or fluid (n = 2). Transition points consisted of a progressively narrowed appendiceal lumen and thickened wall (n = 5) or appendiceal diameter enlargement (n = 9). No cecal apical changes were seen. Scans in all 14 patients were prospectively interpreted as indicative of appendicitis, including 12 (86%) interpreted as indicative of distal appendicitis.
CT findings are useful for the accurate diagnosis of distal appendicitis. Visualization of the proximal appendix alone is insufficient to exclude distal appendicitis.
确定计算机断层扫描（CT）上阑尾远端（远端阑尾炎）的阑尾炎表现，并根据CT表现评估诊断准确性。
回顾了180例经证实患有阑尾炎的连续患者的CT扫描和病历。14例为远端阑尾炎，近端阑尾至少有3厘米长且正常。对阑尾CT扫描及初始报告进行回顾性分析。
近端阑尾塌陷（n = 6）或充满造影剂（n = 6）或气体（n = 2）。发炎的远端阑尾平均直径为13.2毫米，伴有阑尾周围脂肪条索状改变（n = 14）、淋巴结肿大（n = 6）、阑尾结石（n = 4）或积液（n = 2）。移行点包括阑尾腔逐渐变窄和壁增厚（n = 5）或阑尾直径增大（n = 9）。未见盲肠顶端改变。所有14例患者的扫描均被前瞻性解读为提示阑尾炎，其中12例（86%）被解读为提示远端阑尾炎。
CT表现有助于准确诊断远端阑尾炎。仅观察近端阑尾不足以排除远端阑尾炎。
