急腹症

LLQ : Diverticulitis If the pain is located in the LLQ your main concern is sigmoid diverticulitis. In diverticulitis sonography and CT show diverticulosis with segmental colonic wall thickening and inflammatory changes in the fat surrounding a diverticulum.
Acute Abdomen - Practical approach
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The 'acute abdomen' is a clinical condition characterized by severe abdominal pain, requiring the clinician to make an urgent therapeutic decision. This may be challenging, because the differential diagnosis of an acute abdomen includes a wide spectrum of disorders, ranging from life-threatening diseases to benign self-limiting conditions (Table 1). Indicated management may vary from emergency surgery to reassurance of the patient and misdiagnosis may easily result in delayed necessary treatment or unnecessary surgery. Sonography and CT enable an accurate and rapid triage of patients with an acute abdomen. We present practical guidelines on the radiological approach of these patients. Interactive cases are presented in the menubar to test your knowledge.
RUQ : Cholecystitis Cholecystitis occurs when a calculus obstructs the cystic duct. The trapped bile causes inflammation of the gallbladder wall. As gallstones are often occult on CT, sonography is the preferred imaging method for the evaluation of cholecystitis, also allowing assesment of the compressiblity of the gallbladder. The diagnosis of a hydropic galbladder is solely made on the noncompressability of the galbladder. Do not rely on measurements. Some galbladders happen to be small and others are large.
Confirm or exclude the most common disease
inflamed appendix at sonography. Longitudinal (A) and transverse (B) cross-section show a Inflamed appendix at CT. The appendix (arrows) distended noncompressible appendix, is fluid-filled and distended with surrounded by hyperechoic inflamed fat periappendiceal fat-stranding. (arrowheads).
Obstructive ileus. CT depicts distended small bowel loops, but part of the small bowel and the whole colon is nondistended. Therefore this must be an obstructive small bowel ileus, and in this case its cause can easily be identified: intussusception (arrowhead)
Sigmoid diverticulitis at sonography. A hypoechoic thickened diverticulum is surrounded by hyperechoic inflamed fat (arrows).
Uncomplicated sigmoid diverticulitis. Fat stranding and focal thickening of the colonic wall in an area with diverticula. No abscess formation.
Common causes of acute abdomen from life-threatening to self-limiting.
Clinics, laboratory, and plain abdominal film
Both surgical and nonsurgical diseases may present with a similar clinical history and symptoms. Laboratory findings (leucocyte count, erythrocyte sedimentation rate, CRP) are equally nonconclusive. Findings may be normal in patients who need emergency surgery (such as appendicitis) and may be abnormal in patients without a surgical diseaat sonography. Extended-view of the ventral abdomen depicting an area of hyperechoic noncompressible inflamed fat in the omentum (red arrows). Compare this to the echogenicity of normal abdominal or subcutaneous fat (green arrows). This patient Same patient as above. Unenhanced CT depicts had an omental infarction an area of fatty tissue with slightly increased density (arrowheads), in the right-upper quadrant. Compare this to normal low-density subcutaneous fat. Diagnosis: omental infarction
Bowel wall thickening
Thickening of bowel wall indicates inflammation or tumor, and has an extensive differential diagnosis. Thickening of small bowel loops usually indicates regional inflammation, as small bowel tumors (carcinoid, lymphoma, GIST) are relatively infrequent. In patients with local colonic wall thickening a carcinoma is a prime concern.
Plain abdominal film in a patient with an acute abdomen, showing no abnormalities. RIGHT: Subsequent CT shows distended small bowel loops (arrowheads) that are not seen on plain abdominal film because they are filled with fluid only and do not contain intraluminal air
Inflamed fat
Inflamed fat is shown as fat-stranding at CT. Inflamed fat usefully points out where and what the problem is. As a rule, the organ or structure in the centre or nearest to the inflamed fat is the cause of the inflammation.
Screen for general signs of pathology
After excluding these frequent disorders, search for signs of any other pathology, by systematically screening the whole abdomen. Look for inflamed fat, bowel wall thickening, ileus, ascites and free air.