急性右下腹痛.pptxVIP

Case1F，31y（A000345337，History：RLQP for 1day，the ultrasound result showed local low echo-level mass Diagnosis: 1.Typhlitis 2. Fecal impaction of appendixCASE2M，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阑尾炎男，22y，RLQP，恶心、呕吐冠状位图像显示盲肠后方的阑尾：壁增厚，周围脂肪密度增高阑尾炎男，40y，RLQP并向右上腹放射矢状位CT示盲肠后冗长扩张的阑尾，周围炎症反应，肝下脓肿形成。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） 克罗恩病感染性回肠炎免疫缺陷性盲肠结肠炎2、憩室炎 右半结肠及盲肠憩室炎回肠憩室炎阑尾憩室炎 右半结肠憩室炎回肠憩室炎阑尾憩室炎3、恶性肿瘤 腺癌淋巴瘤盲肠癌淋巴瘤4、累及肠脂垂、肠系膜的病变 肠脂垂炎肠系膜淋巴结炎 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 ……………………CT ：the adipose tissue density surrounding the cecum increased，the intestine wall increased thickness and was not clear. ?The lateral conal fascia increased thickness and partly adhesion to the cecum. Several compact nodules was found in the appendix, but the appendiceal wall slightly increased thickness and was almost clear. Multiple lymph nodes was found around the cecum.CT: the appendix was clear, and the adipose tissue was normal. Multiple small Mesenteric lymph node was found, the largest was 0.6cm, some calcification of mesenteric lymph nodes 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 diar