Online Journal
IF値: 1.878(2021年)→1.8(2022年)


Journal of Medical Ultrasonics

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2006 - Vol.33

Vol.33 No.02

Case Report(症例報告)

(229 - 237)

特徴的な超音波像を呈した虫垂粘液嚢胞の3 例

Three Cases of Appendiceal Mucocele: Specific Ultrasonographic Findings

亀田 徹1, 川井 夫規子1, 加瀬 建一2, 篠崎 浩治2, 玉川 英史2, 寺内 寿彰2, 高橋 善明2, 佐藤 政広2, 藤原 美沙2, 植松 繁人2

Toru KAMEDA1, Fukiko KAWAI1, Kenichi KASE2, Hiroharu SHINOZAKI2, Eiji TAMAGAWA2, Toshiaki TERAUCHI2, Yoshiaki TAKAHASHI2, Masahiro SATO2, Misa FUJIWARA2, Shigeto UEMATSU2

1済生会宇都宮病院超音波診断科, 2済生会宇都宮病院外科

1Department of Ultrasound Medicine, Saiseikai Utsunomiya Hospital, 2Department of Surgery, Saiseikai Utsunomiya Hospital

キーワード : appendiceal mucocele, ultrasonography

虫垂粘液嚢胞は比較的稀な疾患で, 偶然無症状で発見されたり, 右下腹部痛や腫瘤触知を契機に診断されるといわれてい る. 特徴的な超音波像を呈した虫垂粘液嚢胞の3 例を経験したので報告する. 症例1 は19 歳, 男性, 右下腹部腫瘤を主 訴に受診. 超音波検査で右傍結腸溝に9.1×3.7 cmの腫瘤を認め, 壁には石灰化があり, 内部は低エコーでたまねぎの 断面のような層状エコーを認めた. 症例2 は70 歳, 女性, 右下腹部違和感を主訴に受診. 右下腹部に圧痛のない腫瘤を 触知した. 超音波検査で回盲部より内側にかけて9.6×3.1 cm大の嚢胞性病変を認め, 内部には症例1 と同様にたまね ぎの断面のような層状構造を認めた. 症例3 は59 歳, 女性, 右下腹部痛を主訴に受診. 右下腹部に圧痛を伴う腫瘤を触 知した. 超音波検査でcup-and-ball 状の嚢胞性腫瘤を伴うmultiple concentric ring sign を認め, 虫垂の嚢胞性病変を巻き 込んだ腸重積が示唆された. 注腸整復後の超音波検査では, 盲腸内腔に2.5×2.0 cmの類円形腫瘤を認め, 腫瘤と連続 した虫垂は径1.1 cmと拡張していた. 超音波検査は虫垂粘液嚢胞の診断に有用である.

Appendiceal mucocele is rarely seen in the clinic. Rather, it is found incidentally or on examination of pain or a palpable mass in the right lower quadrant. We describe three cases of appendiceal mucocele, each of which produced characteristic ultrasound images. Case 1 occurred in a 19-year-old man who complained of a palpable mass in the right lower quadrant of the abdomen. The ultrasonogram showed a 9.1×3.7 cm hypoechoic mass with a calcified wall and internal echogenic layers resembling the cross section of an onion in the right paracolic gutter. Case 2 was that of a 70-year-old woman with discomfort in the right lower quadrant. Abdominal examination detected a palpable mass with no tenderness in the area. The ultrasonogram showed a 9.6×3.1 cm cystic mass with internal echogenic layers similar to those in Case 1 in the medial part of the ileocecum. Case 3 occurred in a 59-year-old woman who complained of pain in the right lower quadrant. Abdominal examination detected a palpable mass accompanied by tenderness in the right lower quadrant. The ultrasonogram showed a multiple concentric ring sign and a cup-and-ball shaped cystic mass in the right upper abdomen, which indicated intussusception with an appendiceal mucocele. The ultrasonogram after barium enema reduction showed a 2.5×2.0 cm oval mass in the cecum connected with the dilated appendix 1.1 cm in diameter. Ultrasonography proved useful for diagnosing appendiceal mucocele.