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.