目的 分析高位急性阑尾炎的临床表现和CT特征,探讨CT诊断高位急性阑尾炎的价值.方法 回顾性分析经手术证实和临床、CT随访证实的高位急性阑尾炎21例.采用16排CT扫描机进行急诊腹部平扫检查,扫描范围分别为上腹、上中腹、中下腹和全腹.由2名放射科医师分别对图像进行分析.结果 21例中,14例(14/21,66.67%)首次腹部CT检查诊断为急性高位阑尾炎;5例结合二次中下腹CT检查诊断急性高位阑尾炎,24 h内正确诊断高位急性阑尾炎19例(19/21,90.48%).盲肠高位合并阑尾高位型6例,阑尾过长高位型15例.CT表现为阑尾增粗伴有壁增厚、阑尾粪石、阑尾周围脂肪层条索影或渗液、阑尾周围炎、结肠炎;间接征象包括盲肠和结肠内、后侧壁增厚、系膜模糊,结肠系膜根部淋巴结增大,回盲部反射性肠郁积.结论 高位急性阑尾炎以阑尾过长型多见,其中单纯型、阑尾周围炎等轻症病例多见.上中腹或全腹CT检查有助于早期发现和准确诊断.%Objective To investigate the clinical features and CT characteristics of high-position acute appendicitis, and to discuss the value of CT in diagnosis of high-position acute appendicitis. Methods Twenty-one patients with high-position acute appendicitis confirmed by surgical pathology or CT following up were analyzed retrospectively. A 16-row MSCT scanner was used to obtain the emergency abdominal CT images. The scan ranges of abdominal CT included upper abdomen, upper-middle abdomen, middle-lower abdomen and entire abdomen, respectively. CT images were analyzed by 2 radiologists. Results High-position acute appendicitis were diagnosed in 14 patients (14/21, 66. 67％) after first CT scan;Five patients of acute appendicitis were diagnosed accompanied with the second CT scan, and totally 19 patients (19/21,90.48％) were accurately diagnosed within 24 h. Six patients were found with cecum and appendices in high position, while 15 with longer appendices. CT showed enlarged appendix, thickened wall and appendiceal fecalith, clouding or stranding of the periappendiceal fat, with periappendicitis and colonitis. The indirect features included thickening of the interior and posterior cecum or colon wall and blurring of mesentery, lymphadenovarix in the radix of mesocolon, sentinel-loop dilatation in ileocecal junction. Conclusion Long appendices are more common in high-position acute appendicitis. Most of these patients appear as simple appendicitis and periappendicitis. Upper-middle abdomen or whole abdomen CT are necessary to diagnosis of high-position acute appendicitis.
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