Nội dung được dịch bởi AI, chỉ mang tính chất tham khảo
Phương pháp đa hình thức trong chẩn đoán hình ảnh những trường hợp cấp cứu bụng không do chấn thương
Tóm tắt
“Bụng cấp” bao gồm dải các tình trạng y tế và phẫu thuật từ các tình trạng ít nghiêm trọng đến nguy hiểm đến tính mạng ở bệnh nhân trình bày với cơn đau bụng dữ dội phát triển qua một khoảng thời gian vài giờ. Việc chẩn đoán chính xác và nhanh chóng các tình trạng này giúp giảm thiểu các biến chứng liên quan. Đánh giá lâm sàng thường khó khăn do sẵn có thuốc giảm đau không kê đơn, dẫn đến các kết quả khám lâm sàng ít đặc hiệu. Quyết định lâm sàng chính là xác định xem có cần thiết can thiệp phẫu thuật hay không. Các kết quả xét nghiệm và hình ảnh X-quang thông thường thường không đặc hiệu. Do đó, chẩn đoán hình ảnh cắt lớp đóng vai trò then chốt trong việc hỗ trợ quản lý bụng cấp. Chụp cắt lớp vi tính là phương pháp chẩn đoán hình ảnh chính được sử dụng cho các trường hợp này do tốc độ chụp hình ảnh nhanh, mặc dù siêu âm có độ đặc hiệu cao hơn cho các tình trạng như viêm túi mật cấp. Chụp hình cộng hưởng từ hoặc siêu âm rất hữu ích cho những bệnh nhân đặc biệt nhạy cảm với bức xạ, chẳng hạn như phụ nữ mang thai và bệnh nhân nhi. Ngoài ra, MRI là một phương tiện giải quyết vấn đề tuyệt vời trong một số tình trạng như đánh giá sỏi ống mật ở bệnh nhân có đau vùng hạ sườn bên phải. Trong bài tổng quan này, chúng tôi thảo luận về phương pháp đa hình thức cho các nguyên nhân thường gặp của bụng cấp không do chấn thương bao gồm viêm ruột thừa cấp, viêm túi thừa, viêm túi mật và tắc ruột non. Một tổng quan ngắn gọn về các nguyên nhân khác tương đối ít gặp nhưng quan trọng của bụng cấp, như thủng tạng rỗng và thiếu máu ruột cũng được bao gồm.
Từ khóa
#bụng cấp #chẩn đoán hình ảnh #viêm ruột thừa cấp #viêm túi thừa #viêm túi mật #tắc ruộtTài liệu tham khảo
Stoker J, van Randen A, Lameris W, Boermeester MA (2009) Imaging patients with acute abdominal pain. Radiology 253(1):31–46. doi:10.1148/radiol.2531090302
MacKersie AB, Lane MJ, Gerhardt RT, et al. (2005) Nontraumatic acute abdominal pain: unenhanced helical CT compared with three-view acute abdominal series. Radiology 237(1):114–122. doi:10.1148/radiol.2371040066
Mirvis SE, Young JW, Keramati B, McCrea ES, Tarr R (1986) Plain film evaluation of patients with abdominal pain: are three radiographs necessary? AJR Am J Roentgenol 147(3):501–503. doi:10.2214/ajr.147.3.501
Sala E, Watson CJ, Beadsmoore C, et al. (2007) A randomized, controlled trial of routine early abdominal computed tomography in patients presenting with non-specific acute abdominal pain. Clin Radiol 62(10):961–969. doi:10.1016/j.crad.2007.01.030
Plewa MC (1991) Emergency abdominal radiography. Emerg Med Clin North Am 9(4):827–852
Young JW (1983) Cutting needless films cuts costs. AJR Am J Roentgenol 140(6):1276–1277. doi:10.2214/ajr.140.6.1276
Abrams HL (1979) The overutilization of X-rays. New Engl J Med 301(12):668
Field S, Guy PJ, Upsdell SM, Scourfield AE (1985) The erect abdominal radiograph in the acute abdomen: should its routine use be abandoned? Br Med J 290(6486):1934–1936
Woodring JH, Heiser MJ (1995) Detection of pneumoperitoneum on chest radiographs: comparison of upright lateral and posteroanterior projections. AJR Am J Roentgenol 165(1):45–47. doi:10.2214/ajr.165.1.7785629
Prasannan S, Zhueng TJ, Gul YA (2005) Diagnostic value of plain abdominal radiographs in patients with acute abdominal pain. Asian J Surg 28(4):246–251. doi:10.1016/S1015-9584(09)60354-7
van Randen A, Lameris W, Luitse JS, OPTIMA Study Group, et al. (2011) The role of plain radiographs in patients with acute abdominal pain at the ED. Am J Emerg Med 29(6):582–589.e582. doi:10.1016/j.ajem.2009.12.020
Boleslawski E, Panis Y, Benoist S, et al. (1999) Plain abdominal radiography as a routine procedure for acute abdominal pain of the right lower quadrant: prospective evaluation. World J Surg 23(3):262–264
Puylaert JB, Rutgers PH, Lalisang RI, et al. (1987) A prospective study of ultrasonography in the diagnosis of appendicitis. New Engl J Med 317(11):666–669. doi:10.1056/NEJM198709103171103
Jamadar DA, Jacobson JA, Morag Y, et al. (2007) Characteristic locations of inguinal region and anterior abdominal wall hernias: sonographic appearances and identification of clinical pitfalls. AJR Am J Roentgenol 188(5):1356–1364. doi:10.2214/AJR.06.0638
Mazzei MA, Guerrini S, Cioffi Squitieri N, et al. (2013) The role of US examination in the management of acute abdomen. Crit Ultrasound J 5(Suppl 1):S6. doi:10.1186/2036-7902-5-S1-S6
Yarmish GM, Smith MP, Rosen MP, et al. (2014) ACR appropriateness criteria right upper quadrant pain. J Am Coll Radiol 11(3):316–322. doi:10.1016/j.jacr.2013.11.017
Khalid M, Redhu N, Nazir B, et al. (2012) Diagnostic value of ultrasonography in evaluation and management of acute abdominal conditions in the paediatric age group. Afr J Paediatr Surg 9(3):198–201. doi:10.4103/0189-6725.104719
Lameris W, van Randen A, van Es HW, Optima Study Group, et al. (2009) Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study. BMJ 338:2431. doi:10.1136/bmj.b2431
Levenson RB, Camacho MA, Horn E, et al. (2012) Eliminating routine oral contrast use for CT in the emergency department: impact on patient throughput and diagnosis. Emerg Radiol 19(6):513–517. doi:10.1007/s10140-012-1059-7
Uyeda JW, Yu H, Ramalingam V, et al. (2015) Evaluation of acute abdominal pain in the emergency setting using computed tomography without oral contrast in patients with body mass index greater than 25. J Comp Assist Tomogr 39(5):681–686. doi:10.1097/RCT.0000000000000277
Alabousi A, Patlas MN, Sne N, Katz DS (2015) Is oral contrast necessary for multidetector computed tomography imaging of patients with acute abdominal pain? Can Assoc Radiol J. doi:10.1016/j.carj.2015.03.003
Rosen MP, Ding A, Blake MA, et al. (2011) ACR appropriateness criteria(R) right lower quadrant pain—suspected appendicitis. J Am Coll Radiol 8(11):749–755. doi:10.1016/j.jacr.2011.07.010
Mieville FA, Gudinchet F, Brunelle F, Bochud FO, Verdun FR (2013) Iterative reconstruction methods in two different MDCT scanners: physical metrics and 4-alternative forced-choice detectability experiments—a phantom approach. Phys Med 29(1):99–110. doi:10.1016/j.ejmp.2011.12.004
Lubarsky M, Kalb B, Sharma P, Keim SM, Martin DR (2013) MR imaging for acute nontraumatic abdominopelvic pain: rationale and practical considerations. Radiographics 33(2):313–337. doi:10.1148/rg.332125116
Pedrosa I, Rofsky NM (2003) MR imaging in abdominal emergencies. Radiol Clin North Am 41(6):1243–1273
Birchard KR, Brown MA, Hyslop WB, Firat Z, Semelka RC (2005) MRI of acute abdominal and pelvic pain in pregnant patients. AJR Am J Roentgenol 184(2):452–458. doi:10.2214/ajr.184.2.01840452
Tkacz JN, Anderson SA, Soto J (2009) MR imaging in gastrointestinal emergencies. Radiographics 29(6):1767–1780. doi:10.1148/rg.296095509
Singh A, Danrad R, Hahn PF, et al. (2007) MR imaging of the acute abdomen and pelvis: acute appendicitis and beyond. Radiographics 27(5):1419–1431. doi:10.1148/rg.275065021
Deng Y, Chang DC, Zhang Y, et al. (2010) Seasonal and day of the week variations of perforated appendicitis in US children. Pediatr Surg Int 26(7):691–696. doi:10.1007/s00383-010-2628-z
Jacobs JE (2006) CT and sonography for suspected acute appendicitis: a commentary. AJR Am J Roentgenol 186(4):1094–1096. doi:10.2214/AJR.06.0174
Addiss DG, Shaffer N, Fowler BS, Tauxe RV (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132(5):910–925
Storm-Dickerson TL, Horattas MC (2003) What have we learned over the past 20 years about appendicitis in the elderly? Am J Surg 185(3):198–201
Tamburrini S, Brunetti A, Brown M, Sirlin CB, Casola G (2005) CT appearance of the normal appendix in adults. Eur Radiol 15(10):2096–2103. doi:10.1007/s00330-005-2784-z
Kim HC, Yang DM, Lee CM, et al. (2011) Acute appendicitis: relationships between CT-determined severities and serum white blood cell counts and C-reactive protein levels. Br J Radiol 84(1008):1115–1120. doi:10.1259/bjr/47699219
Lai V, Chan WC, Lau HY, et al. (2012) Diagnostic power of various computed tomography signs in diagnosing acute appendicitis. Clin Imag 36(1):29–34. doi:10.1016/j.clinimag.2011.04.003
Kim MS, Park HW, Park JY, et al. (2014) Differentiation of early perforated from nonperforated appendicitis: MDCT findings, MDCT diagnostic performance, and clinical outcome. Abdom Imag 39(3):459–466. doi:10.1007/s00261-014-0117-x
Karabulut N, Kiroglu Y, Herek D, Kocak TB, Erdur B (2014) Feasibility of low-dose unenhanced multi-detector CT in patients with suspected acute appendicitis: comparison with sonography. Clin Imag 38(3):296–301. doi:10.1016/j.clinimag.2013.12.014
Pedrosa I, Levine D, Eyvazzadeh AD, et al. (2006) MR imaging evaluation of acute appendicitis in pregnancy. Radiology 238(3):891–899. doi:10.1148/radiol.2383050146
Incesu L, Coskun A, Selcuk MB, et al. (1997) Acute appendicitis: MR imaging and sonographic correlation. AJR Am J Roentgenol 168(3):669–674. doi:10.2214/ajr.168.3.9057512
Stark C, Jousi M, Enholm B (2014) Preoperative assessment and treatment of appendiceal mucocele complicated by acute torsion: a case report. BMC Res Notes 7:1. doi:10.1186/1756-0500-7-1
Rao PM, Rhea JT, Novelline RA (1997) CT diagnosis of mesenteric adenitis. Radiology 202(1):145–149. doi:10.1148/radiology.202.1.8988204
Lameris W, van Randen A, van Gulik TM, et al. (2010) A clinical decision rule to establish the diagnosis of acute diverticulitis at the emergency department. Dis Colon Rectum 53(6):896–904. doi:10.1007/DCR.0b013e3181d98d86
Schwerk WB, Schwarz S, Rothmund M (1992) Sonography in acute colonic diverticulitis. A prospective study. Dis Colon Rectum 35(11):1077–1084
Rao PM, Rhea JT, Novelline RA, et al. (1998) Helical CT with only colonic contrast material for diagnosing diverticulitis: prospective evaluation of 150 patients. AJR Am J Roentgenol 170(6):1445–1449. doi:10.2214/ajr.170.6.9609151
Hinchey EJ, Schaal PG, Richards GK (1978) Treatment of perforated diverticular disease of the colon. Adv Surg 12:85–109
Kaiser AM, Jiang JK, Lake JP, et al. (2005) The management of complicated diverticulitis and the role of computed tomography. Am J Gastroenterol 100(4):910–917. doi:10.1111/j.1572-0241.2005.41154.x
Shen SH, Chen JD, Tiu CM, et al. (2005) Differentiating colonic diverticulitis from colon cancer: the value of computed tomography in the emergency setting. J Chin Med Assoc 68(9):411–418. doi:10.1016/S1726-4901(09)70156-X
Buckley O, Geoghegan T, McAuley G, et al. (2007) Pictorial review: magnetic resonance imaging of colonic diverticulitis. Eur Radiol 17(1):221–227. doi:10.1007/s00330-006-0236-z
Oistamo E, Hjern F, Blomqvist L, Von Heijne A, Abraham-Nordling M (2013) Cancer and diverticulitis of the sigmoid colon. Differentiation with computed tomography versus magnetic resonance imaging: preliminary experiences. Acta Radiol 54(3):237–241. doi:10.1258/ar.2012.120543
Foster NM, McGory ML, Zingmond DS, Ko CY (2006) Small bowel obstruction: a population-based appraisal. J Am Coll Surg 203(2):170–176. doi:10.1016/j.jamcollsurg.2006.04.020
Maglinte DD, Howard TJ, Lillemoe KD, Sandrasegaran K, Rex DK (2008) Small-bowel obstruction: state-of-the-art imaging and its role in clinical management. Clin Gastroenterol Hepatol 6(2):130–139. doi:10.1016/j.cgh.2007.11.025
Burkill GJ, Bell JR, Healy JC (2001) The utility of computed tomography in acute small bowel obstruction. Clin Radiol 56(5):350–359. doi:10.1053/crad.2000.0655
Maglinte DD, Heitkamp DE, Howard TJ, Kelvin FM, Lappas JC (2003) Current concepts in imaging of small bowel obstruction. Radiol Clin North Am 41(2):263–283, vi
Lappas JC, Reyes BL, Maglinte DD (2001) Abdominal radiography findings in small-bowel obstruction: relevance to triage for additional diagnostic imaging. AJR Am J Roentgenol 176(1):167–174. doi:10.2214/ajr.176.1.1760167
Mullan CP, Siewert B, Eisenberg RL (2012) Small bowel obstruction. AJR Am J Roentgenol 198(2):W105–W117. doi:10.2214/AJR.10.4998
Di Saverio S, Catena F, Ansaloni L, et al. (2008) Water-soluble contrast medium (gastrografin) value in adhesive small intestine obstruction (ASIO): a prospective, randomized, controlled, clinical trial. World J Surg 32(10):2293–2304. doi:10.1007/s00268-008-9694-6
Schmutz GR, Benko A, Fournier L, et al. (1997) Small bowel obstruction: role and contribution of sonography. Eur Radiol 7(7):1054–1058. doi:10.1007/s003300050251
Duron JJ, Silva NJ, du Montcel ST, et al. (2006) Adhesive postoperative small bowel obstruction: incidence and risk factors of recurrence after surgical treatment: a multicenter prospective study. Ann Surg 244(5):750–757. doi:10.1097/01.sla.0000225097.60142.68
Delabrousse E, Lubrano J, Jehl J, et al. (2009) Small-bowel obstruction from adhesive bands and matted adhesions: CT differentiation. AJR Am J Roentgenol 192(3):693–697. doi:10.2214/AJR.08.1550
Yen CH, Chen JD, Tui CM, et al. (2005) Internal hernia: computed tomography diagnosis and differentiation from adhesive small bowel obstruction. J Chin Med Assoc 68(1):21–28. doi:10.1016/S1726-4901(09)70127-3
Millet I, Ruyer A, Alili C, et al. (2014) Adhesive small-bowel obstruction: Value of CT in identifying findings associated with the effectiveness of nonsurgical treatment. Radiology 273(2):425–432. doi:10.1148/radiol.14132872
Fidler JL, Guimaraes L, Einstein DM (2009) MR imaging of the small bowel. Radiographics 29(6):1811–1825. doi:10.1148/rg.296095507
Prystowsky JB, Pugh CM, Nagle AP (2005) Current problems in surgery. Appendicitis. Curr Probl Surg 42(10):688–742. doi:10.1067/j.cpsurg.2005.07.005
Fagenholz PJ, de Moya MA (2014) Acute inflammatory surgical disease. Surg Clin North Am 94(1):1–30. doi:10.1016/j.suc.2013.10.008
Hirota M, Takada T, Kawarada Y, et al. (2007) Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. J Hepato-Biliary-Pancreatic Surg 14(1):78–82. doi:10.1007/s00534-006-1159-4
Harvey RT, Miller WT Jr (1999) Acute biliary disease: initial CT and follow-up US versus initial US and follow-up CT. Radiology 213(3):831–836. doi:10.1148/radiology.213.3.r99dc17831
Watanabe Y, Nagayama M, Okumura A, et al. (2007) MR imaging of acute biliary disorders. Radiographics 27(2):477–495. doi:10.1148/rg.272055148
Patel NB, Oto A, Thomas S (2013) Multidetector CT of emergent biliary pathologic conditions. Radiographics 33(7):1867–1888. doi:10.1148/rg.337125038
Hasan MK, Itoi T, Varadarajulu S (2013) Endoscopic management of acute cholecystitis. Gastrointest Endosc Clin North Am 23(2):453–459. doi:10.1016/j.giec.2012.12.010
Cadenas Rodriguez L, Marti de Gracia M, Saturio Galan N, et al. (2013) Use of multidetector computed tomography for locating the site of gastrointestinal tract perforations. Cir Esp 91(5):316–323. doi:10.1016/j.ciresp.2012.06.004
Furukawa A, Sakoda M, Yamasaki M, et al. (2005) Gastrointestinal tract perforation: CT diagnosis of presence, site, and cause. Abdom Imag 30(5):524–534. doi:10.1007/s00261-004-0289-x
Cho KC, Baker SR (1994) Extraluminal air. Diagnosis and significance. Radiol Clin North Am 32(5):829–844
Cho KC, Baker SR (1991) Air in the fissure for the ligamentum teres: new sign of intraperitoneal air on plain radiographs. Radiology 178(2):489–492. doi:10.1148/radiology.178.2.1987613
Cho HS, Yoon SE, Park SH, et al. (2009) Distinction between upper and lower gastrointestinal perforation: usefulness of the periportal free air sign on computed tomography. Eur J Radiol 69(1):108–113. doi:10.1016/j.ejrad.2007.08.024
Horton KM, Fishman EK (2001) Multi-detector row CT of mesenteric ischemia: can it be done? Radiographics 21(6):1463–1473. doi:10.1148/radiographics.21.6.g01nv091463
Lee R, Tung HK, Tung PH, Cheung SC, Chan FL (2003) CT in acute mesenteric ischaemia. Clin Radiol 58(4):279–287
Gandhi SK, Hanson MM, Vernava AM, Kaminski DL, Longo WE (1996) Ischemic colitis. Dis Colon Rectum 39(1):88–100
Oliva IB, Davarpanah AH, Rybicki FJ, et al. (2013) ACR appropriateness criteria (R) imaging of mesenteric ischemia. Abdom Imag 38(4):714–719. doi:10.1007/s00261-012-9975-2
Cangemi JR, Picco MF (2009) Intestinal ischemia in the elderly. Gastroenterol Clin North Am 38(3):527–540. doi:10.1016/j.gtc.2009.06.002
Segatto E, Mortele KJ, Ji H, Wiesner W, Ros PR (2003) Acute small bowel ischemia: CT imaging findings. Semin Ultrasound CT MR 24(5):364–376
Taourel PG, Deneuville M, Pradel JA, Regent D, Bruel JM (1996) Acute mesenteric ischemia: diagnosis with contrast-enhanced CT. Radiology 199(3):632–636. doi:10.1148/radiology.199.3.8637978
Bartnicke BJ, Balfe DM (1994) CT appearance of intestinal ischemia and intramural hemorrhage. Radiol Clin North Am 32(5):845–860
Klein HM, Lensing R, Klosterhalfen B, Tons C, Gunther RW (1995) Diagnostic imaging of mesenteric infarction. Radiology 197(1):79–82. doi:10.1148/radiology.197.1.7568858
Connor R, Jones B, Fishman EK, Siegelman SS (1984) Pneumatosis intestinalis: role of computed tomography in diagnosis and management. J Comp Assist Tomogr 8(2):269–275