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Stomach and Intestine(Tokyo) Volume 25, Issue 10 （October 1990）

胃と腸 25巻10号（1990年10月発行）

Japanese English

今月の主題中垂腫瘤

主題

虫垂腫瘤様病変における注腸X線所見―他の画像診断との比較 Barium Enema Findings of Appendiceal Mass Lesions: Comparison with Other Imaging Findings 北川晋二 ¹ , 本岡慎 ¹ , 平田展章 ¹ , 川元健二 ¹ , 吉満研吾 ¹ , 増田康治 ¹ , 森正樹 ² , 植山敏彦 ³ , 下田悠一郎 ⁴ , 野尻五千穂 ⁵ , 小野村健太郎 ⁶ , 原口幸昭 ⁷ Shinji Kitagawa ¹ , Makoto Motooka ¹ , Nobuaki Hirata ¹ ¹九州大学医学部放射線科 ²九州大学第2外科 ³九州大学第2病理 ⁴佐賀県立病院好生館放射線科 ⁵佐賀医科大学放射線科 ⁶産業医科大学放射線科 ⁷早良病院胃腸科 ¹Department of Radiology, Faculty of Medicine, Kyushu University キーワード：虫垂腫瘍 , 虫垂癌 , 虫垂粘液囊胞腺腫 , 虫垂周囲膿瘍 , 注腸X線所見 Keyword: 虫垂腫瘍 , 虫垂癌 , 虫垂粘液囊胞腺腫 , 虫垂周囲膿瘍 , 注腸X線所見 pp.1155-1168

発行日 1990年10月25日 Published Date 1990/10/25

DOI https://doi.org/10.11477/mf.1403111475

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要旨　虫垂腫瘤様病変を，虫垂癌（以下ACA）：11例，虫垂粘液囊胞腺腫（以下AMCA）：6例，虫垂周囲膿瘍（以下PAA）：12例の3つに規定し，計29例を対象とした．すべて注腸X線検査を施行し，そのX線所見と他の画像診断所見とを比較した．注腸X線所見のほとんどは，管外性圧排か粘膜下腫瘍様隆起であった．ACAとPAAには偏側性の辺不整が多い傾向であった．AMCAは管腔内の粘膜下腫瘍様の隆起を呈するものが多かった．虫垂の描出は，ACAとPAAに5例認められたが，AMCAにはなかった．虫垂開口部の変形はAMCAの33％にみられた．各画像診断の特徴は以下のごとくであった．ACAの粘液囊胞腺癌では，CT・USで粘液囊胞成分の所見が特徴的であった．血管，RI検査は癌に特異的ではなかった．AMCAには，CT・USが極めて有用であった．PAAでは管外性の膿瘍の所見をCT・USで検出できれば診断可能であった．なお，内視鏡検査は管外性圧排がみられるのみで診断には有用でなかった．

　Appendiceal mass lesions were investigated in 29 patients. Final diagnosis included appendiceal carcinoma (ACA) in 11 patients, appendiceal mucinous cystadenoma (AMCA) in 6, and periappendiceal abscess (PAA) in 12. All these patients underwent barium enema study, the findings of which were compared with those of other imaging techniques.

　The subject patients included 19 men (66%) and 10 women (34%), ranging in age from 3 to 77, with a mean of 53 years. In most of the patients with ACA, the chief complaint was ileocecal mass, while in those with PAA, it was ileocecal pain. CEA was elevated in 67% of the patients with ACA, leucocytosis was found in 82% of PAA, and ESR was elevated (over 43 mm/hr) in all patients with PAA. Preoperative diagnosis was correct in about 50% of the cases of ACA and AMCA, and in almost all cases of PAA.

　Barium enema findings observed in these three diseases were extrinsic compressions or elevations simulating submucosal tumor (SMT). The appendix itself was delineated in 2 cases of ACA, in 3 cases of PAA, and in no case of AMCA. In 33% of the cases of AMCA, the deformity of appendiceal orifice was noted.

　The findings by other imaging techniques in each lesion were as follows; in mucinous cystadenocarcinoma in ACA, CT and US were useful in detecting the cystic component of the lesion, while the findings of angiography and ⁶⁷Ga scintigraphy were not specific for ACA; in AMCA, CT and US were extremely useful; CT and US contributed to the diagnosis of PAA when extraluminal abscess was successfully visualized; endoscopic findings including compression or SMT-like elevation were not specific in either of three lesions.

　It was concluded that appendiceal mass lesions may be correctly diagnosed by barium enema study combined with clinical informations and other imaging findings.