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儿科超声检查与阑尾炎
原作者: Mimi Lu,肖锋译 发布日期:2013-05-20

Title: Pediatric ultrasound and appendicitis
题目:儿科超声检查与阑尾炎
Author 作者: Mimi Lu

An overweight 5 year old male presents with acute onset abdominal pain that localizes to the right lower quadrant. What are some causes of a limited or nondiagnostic ultrasound study in children?
一个超体重的5岁男孩,以急性右下腹腹痛就诊。造成超声检查在儿童中受限或不能确诊的原因有哪些?
Acute appendicitis is a time sensitive diagnosis. Ultrasound is frequently used as the initial diagnostic imaging in children. There are several reasons why the appendix may not be visualized, including retro-cecal location, normal appendix, perforation, and inflammation around the distal tip. An additional clinical predictor associated with poor or inconclusive ultrasound results in appendicitis is increased BMI (body mass index).
急性阑尾炎是要快速诊断的。超声在儿科病人中经常被用来作为初始诊断的影像检查手段。有几个原因可以来解释为什么有时候会看不到阑尾,包括盲肠后的位置,正常阑尾,穿孔,和尖端周围发炎。另外一个造成超声检查结果质量不高或不能确定阑尾炎的临床预测指标是高BMI(体重指数)。
A study examining 263 pediatric patients found when BMI > 85th percentile and clinical probability of appendicitis was <50%, 58% of ultrasounds were nondiagnostic. Children with a BMI <85th percentile and clinical probability of appendicitis was <50%, had nondiagonstic scans 42% of the time. These trends were also mimicked in the patients with a higher clinical probability of appendicitis. In the child with a nondiagnostic ultrasound, options include observation and repeat ultrasound scan or CT scan, both of which have associated risks.
包括263小儿患者的一项研究发现,当BMI>85百分位和阑尾炎临床可能性<50%时,58%的超声波不能明确诊断。 BMI<85百分位和阑尾炎临床可能性<50%的儿童,有42%的超声检查不能明确诊断。在临床阑尾炎可能性很高的患者中也有类式的趋势。对于超声不能明确诊断的孩子,可选择观察和重复超声波检查或CT扫描,当然这两者都有一定的风险。
Reference 参考文献:
Schuh S, et al. Predictors of non-diagnostic ultrasound scanning in children with suspected appendicitis. J Pediatr. 2011 Jan;158(1):112-8.