Evaluation of whether the ultrasonographic onion skin sign is specific for the diagnosis of an appendiceal mucocele

Kameda, Tomohiro; Kawai, Fukiko; Taniguchi, Nobuyuki; Omoto, Kiyoka; Kobori, Yasuyuki; Arakawa, Kazukiyo

doi:10.1007/s10396-014-0527-y

Cited by 15 publications

(13 citation statements)

References 39 publications

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“…Typically US shows a distended fluid filled appendix, with variable internal echogenicity depending on the internal content and consistency (aqueous or gelatinous), which may be anechoic, hypoechoic or heterogeneous (onion skin sign) [123][124][125][126] (fig 12). The onion skin sign defined as echogenic layers or a layered appearance of the internal contents of the mass have been described as specific of AM [124].…”

Section: Mucocelementioning

confidence: 99%

EFSUMB Gastrointestinal Ultrasound (GIUS) Task Force Group: Celiac sprue and other rare gastrointestinal diseases ultrasound features

et al. 2019

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Transabdominal gastrointestinal ultrasound (GIUS) is unique in its capacity to examine the bowel non-invasively and in its physiological condition, including extra-intestinal features such as the splanchnic vessels, mesentery, omentum and lymph nodes- even at the bedside. Despite this, and its extensive documentation for its usefulness, it has only been fully implemented in a few European countries and expert centres. Therefore, the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) established a GIUS Task Force Group in 2014 consisting of international experts from 9 European countries with the objectives to standardize and promote the use of GIUS in a clinical setting. This is achieved by publishing clinical guidelines and recommendations on indications and use of GIUS and so far,4 guidelines have been published: first on “examination techniques and normal findings”, second on “inflammatory bowel disease”, third on “acute appendicitis and diverticulitis” and fourth on “transrectal and perineal ultrasound”.This paper describes the ultrasound features of miscellaneous disorders such as celiac disease, cystic fibrosis, omental infarction, Meckel’s diverticle, endometriosis, intestinal neoplasia, mucocele, amyloidosis, GVHD, foreign bodies, vasculitis, and pneumatosis cystoides intestinalis. Bowel ultrasound can be indicated in most of these conditions to investigate intestinal symptoms but in other cases the alterations of the bowel can be also an incidental finding that suggest other examinations which finally help to discover an unknown pathological condition.

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Section: Mucocelementioning

confidence: 99%

EFSUMB Gastrointestinal Ultrasound (GIUS) Task Force Group: Celiac sprue and other rare gastrointestinal diseases ultrasound features

et al. 2019

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“…Appendiceal neoplasm studied on US is defined by some features: diameter larger than 1,5 cm, "onion skin" appearance, nodular enhancing of wall [5]. RMI is superior in studying peritoneal lesions.…”

Section: Discussionmentioning

confidence: 99%

High risk of delayed or missed diagnosis of mucinous appendiceal neoplasm by transvaginal ultrasound: A case series

Rizzello¹,

Vannucci²,

Coccia³

2021

J Clin Images Med Case Rep

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Appendiceal Neoplasm is a rare tumour with a vague and nonspecific clinical presentation. Delayed or missed diagnosis could result in mucin spill into the peritoneal cavity because of cancer infiltration or spontaneous rupture of appendix. This condition is called Psuedomyxoma Peritonei (PMP) and has a very poor prognosis if not treated properly. We present 4 cases of Appendiceal Neoplasm misdiagnosed as adnexal masses of different origin: Dermoid cyst of the right ovary; stump of the previously removed tube; ectopic pregnancy; ovarian malignancy. It is important for gynaecologists to recognize mucinous appendiceal neoplasm in the differential diagnosis of right adnexal masses in order to reduce the risk of misdiagnosis. Keywords: Appendiceal Neoplasm, Adnexal Masses, Transvaginal Ultrasound, Misdiagnosis.

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“…Abdominal imaging has an important role in the diagnosis of LAMN and patient follow-up. Abdominal ultrasound may identify a cystic mass with mucinous content in the right lower quadrant of the abdomen [14]. Abdominal computed tomography (CT) may show a well-demarcated cystic mass in the appendix with low attenuation of the contents [15].…”

Section: Discussionmentioning

confidence: 99%

A Case of Strangulation Ileus Due to a Low-Grade Appendiceal Mucinous Neoplasm

et al. 2020

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Objective:Rare disease Background:Strangulation ileus is caused by external obstruction to the small bowel, which results in ischemia and loss of bowel peristalsis. Low-grade appendiceal mucinous neoplasm (LAMN) is a low-grade adenocarcinoma that arises in the appendix. LAMN is usually asymptomatic but can present with appendiceal rupture and pseudomyxoma peritonei (PMP). This report is of a rare presentation of LAMN with strangulation ileus in a 92-yearold man. Case Report:A 92-year-old man was admitted to the emergency room with sudden onset of lower abdominal pain and abdominal distension. Laboratory investigations showed a leukocytosis with a white blood cell (WBC) count of 14.6×10 3 /μL with 85.5% neutrophils, blood urea nitrogen (BUN) of 26.6 mg/dL, and serum creatinine of 2.6 mg/dL, consistent with acute renal failure. Arterial blood gas analysis showed lactic acidosis (pH of 7.11) with a base excess of -20.8 mmol/L and lactate of 13.7 mmol/L. Abdominal computed tomography (CT) showed ascites and a dilated obstructed closed loop of the distal ileum associated with an external mass (3.9×2.8 cm). An initial diagnosis was of strangulation ileus due to Meckel's diverticulum. Emergency ileocecal resection was performed. Histopathology showed a low-grade mucinous tumor arising from the mucosa of the appendix, consistent with LAMN. At a 13-month follow-up, the patient was well with no tumor recurrence. Conclusions:This report is of a rare case of LAMN that presented as a surgical emergency with strangulation ileus.

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Evaluation of whether the ultrasonographic onion skin sign is specific for the diagnosis of an appendiceal mucocele

Abstract: The onion skin sign in the lower abdomen appears to be specific for the diagnosis of an appendiceal mucocele. In cases where the onion skin sign is obviously present in the lower abdomen on US, an appendiceal mucocele should be considered as the leading diagnosis.

Cited by 15 publications

References 39 publications

EFSUMB Gastrointestinal Ultrasound (GIUS) Task Force Group: Celiac sprue and other rare gastrointestinal diseases ultrasound features

EFSUMB Gastrointestinal Ultrasound (GIUS) Task Force Group: Celiac sprue and other rare gastrointestinal diseases ultrasound features

High risk of delayed or missed diagnosis of mucinous appendiceal neoplasm by transvaginal ultrasound: A case series

A Case of Strangulation Ileus Due to a Low-Grade Appendiceal Mucinous Neoplasm

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