内田 浩也¹, 奥野 敏隆², 川崎 俊彦³, 前西 文秋¹, 東 貞之¹, 堀川 里紀¹, 榊原 由希¹, 登尾 薫¹, 小森 英司³, 三村 純³, 井谷 智尚³, 仲瀬 裕志³

Hiroya UCHIDA¹, Toshitaka OKUNO², Toshihiko KAWASAKI³, Fumiaki MAENISHI¹, Sadayuki AZUMA¹, Riki HORIKAWA¹, Yuki SAKAKIBARA¹, Kaoru NOBORIO¹, Hideshi KOMORI³, Jun MIMURA³, Toshinao ITANI³, Hiroshi NAKASE³

¹西神戸医療センター臨床検査技術部, ²西神戸医療センター外科, ³西神戸医療センター内科

¹Clinical Laboratory, Nishi-Kobe Medical Center, ²Department of Surgery, Nishi-Kobe Medical Center, ³Department of Internal Medicine, Nishi-Kobe Medical Center

キーワード : Appendicitis, Blood flow signals, Power Doppler, Ultrasonography

Although ultrasonography (US) has been used widely to diagnose acute appendicitis, it does not readily distinguish between normal and inflamed vermiform appendixes that are slightly enlarged (5 to 7 mm in maximal outer diameter). It is also difficult to determine severity of acute appendicitis when gray-scale US is used alone. Here we attempt to determine whether or not power Doppler US can be useful for determining severity of acute appendicitis. Sixteen patients with acute appendicitis and 10 patients with normal appendixes were evaluated with power Doppler US. One of the 16 patients with acute appendicitis had catarrhal appendicitis; 9, phlegmonous appendicitis; 4, gangrenous appendicitis; and 2, perforative appendicitis, and 9 of the 16 had blood-flow signals in the submucosal layer. One of the 9 with blood-flow signals in the submucosal layer had catarrhal appendicitis; 6, phlegmonous appendicitis; and 2, perforated appendicitis. Three of the remaining 7 patients, who had no blood-flow signals in the submucosal layer, had phlegmonous appendicitis, and 4 had gangrenous appendicitis. No blood-flow signals were found in the normal appendixes. We considered that blood-flow signals were present in the submucosal layer of patients with catarrhal and phlegmonous appendicitis but absent in patients with normal appendixes and those with gangrenous appendicitis. We thus conclude that combined use of power Doppler and gray-scale US enabled us to distinguish between catarrhal, phlegmonous, and gangrenous appendicitis. Power Doppler US can serve as a useful tool for determining grade of acute appendicitis.