急性右下腹痛.ppt

急性“右下腹痛”（RLQP）鉴别诊断 Case1 F，31y（A000345337， History：RLQP for 1day，the ultrasound result showed local low echo-level mass Diagnosis: 1.Typhlitis 2. Fecal impaction of appendix CASE2 M，28y（A000444125， History：RLQP，the ER diagnosis was Appendicitis ? Appendicular perforation ? Diagnosis: Multiple small mesenteric lymph node (Mesenteric adenitis ?) 急性右下腹痛！！！ 腹痛是急诊病人最常见的主诉之一 右下腹痛 (RLQP) 是其中最具挑战性的临床表现之一，最常见的病因是急性阑尾炎及阑尾穿孔 须与多种疾病相鉴别，包括是否存在危及生命的情况及是否需要行急诊手术 当CT显示阑尾未见异常或阑尾未显影时，阑尾炎可以除外，那么其他的诊断？ 在作出鉴别诊断的过程中，扫描范围应包括从膈顶到耻骨联合的整个腹部及盆腔 对于鉴别诊断有很大意义 病因分类 回盲部炎性及感染性病变 憩室炎 恶性肿瘤 累及肠脂垂和肠系膜的病变 其他少见病因 1、回盲部炎性及感染性病变 克罗恩病 感染性小肠/结肠炎 中性粒细胞减少症结肠炎（盲肠炎） 克罗恩病 2、憩室炎 右半结肠及盲肠憩室炎 回肠憩室炎 阑尾憩室炎 3、恶性肿瘤 腺癌 淋巴瘤 4、累及肠脂垂、肠系膜的病变 肠脂垂炎 肠系膜淋巴结炎 5、其他病因 子宫内膜异位症 异物食入 肠套叠 盲肠扭转 缺血性结肠炎 …………………… Appendicitis in a 22-year-old man with RLQP, nausea, and vomiting. Coronal CT image shows a retrocecal appendix (arrows) with a thick hyperenhancing wall and adjacent fat stranding. Appendicitis in a 40-year-old man with RLQP radiating to the upper quadrant. Sagittal CT image shows a long, dilated retrocecal appendix (arrowheads) with similar inflammatory changes located in the subhepatic recess. The appendix in this case would be incompletely identified if only limited images of the right lower quadrant were obtained. Crohn disease in a 26-year-old man with RLQP and diarrhea. Coronal oblique CT image shows a thickened terminal ileum with strictures and mucosal hyperenhancement (white arrow). There is also proliferation of the mesenteric fat (black arrow). Crohn disease in a 23-year-old woman with RLQP and fever. (a) Axial oblique CT image shows a thick-walled terminal ileum (black arrow) proximal to the ileocecal valve (white arrow) with adjacent fibrofatty proliferation (arrowheads). Note that positive oral contrast material was administered, which limits the observation of the mucosal hyperenhancement Infectious ileitis in a 32-year-old man with RLQP, fever, and b