肾脏局灶性囊性病变.ppt
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肾脏局灶性囊性病变.ppt
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LocalizedCysticDiseaseoftheKidney肾脏局灶性囊性病变肾脏局灶性囊性病变IntroductionnLocalizedcysticdiseaseofthekidneyisabenignnonsurgicalcondition.肾局灶囊性病变是一种良性的非手术治疗的肾脏疾病nItsimagingandclinicalfeaturesarecharacterizedanddifferentiatedfromautosomaldominantpolycystickidneydisease,multilocularcysticnephroma,andcysticneoplasm.它的影像学和临床特征与常染色体显性遗传性多囊肾病、多房性囊性肾脏肿瘤、肾脏肿瘤囊变有区别IntroductionnLocalizedcysticdiseaseofthekidneyhasbeenreferredtobyanumberofdifferentnames,includingsegmentalcysticdiseaseofthekidneywhenitinvolvesjustoneportionofonekidney,orunilateralcysticdiseaseofthekidneywhenitinvolvesallofonekidney.肾脏局灶性囊性病肾脏局灶性囊性病变有不同的名称,包含肾的阶段性囊肿性变有不同的名称,包含肾的阶段性囊肿性病变(它累及一个肾的某一部分),或者病变(它累及一个肾的某一部分),或者肾脏的单侧囊性病变(累及一个肾脏的全肾脏的单侧囊性病变(累及一个肾脏的全部)部)IntroductionnIthasalsobeenreferredtoas“unilateralpolycysticdisease”.Thelattertermmaybemisleadingandshouldbediscardedbecausethislesionbearsnorelationshiptoautosomaldominantpolycystickidneydisease,whichisafamilialdiseasewithavarietyofassociatedconditions,noneofwhichareseeninlocalizedcysticdisease.它亦指单侧的它亦指单侧的先天性多囊肾,但后者术语可能被误解先天性多囊肾,但后者术语可能被误解,应该抛弃应该抛弃,因为这种病变与常染色体显性遗传性多囊肾并没因为这种病变与常染色体显性遗传性多囊肾并没有关系有关系,后者是一个家族性疾病,有各种各样的相后者是一个家族性疾病,有各种各样的相关条件,几乎没有一个表现为肾脏局灶性囊性病关条件,几乎没有一个表现为肾脏局灶性囊性病变。
变。
IntroductionnLocalizedcysticdiseasewasunilateralinallpatientsandcharacterizedbymultiplecystsofvarioussizesseparatedbynormal(oratrophic)renaltissueinaconglomeratemasssuggestiveofcysticneoplasm若病变单侧发病,在团块状肿块内出现不同尺寸的多发囊肿被正常(或萎缩)的肾组织分隔多提示为囊性肿瘤nClinicalpresentationsincludedhematuria,flankpain,palpableabdominalmass,andlocalizedcysticdiseaseasanincidentalfinding临床表现包括血尿,腹痛、可触及的腹部肿块和偶然发现局部囊性病变nNoneofthepatientshadafamilyhistoryofautosomaldominantpolycystickidneydisease.所有的病人均无常染色体显性遗传性多囊肾病的家族史nFamiliaritywithlocalizedcysticdiseaseofthekidneyanditsimagingfindingsisimportanttoavoidunnecessarysurgeryandtodifferentiatethediseasefromautosomaldominantpolycystickidneydisease熟悉肾脏的局部囊性疾病和它的影像学表现是重要的,以避免不必要的外科手术,并且和常染色体显性遗传性多囊肾相区别IntroductionIntroductionnCysticdiseasesofthekidneyencompassawidespectrumofcauses,manifestations,andtreatments肾脏囊性病变的病因、临床表现与治疗各不相同nLocalizedcysticdiseaseisanuncommonpresentationofrenalcysticdiseaseandhasbeenconfusedwithunilateralautosomaldominantpolycystickidneydisease,multilocularcysticnephroma,orcysticneoplasm.肾脏局灶性囊性病变是肾脏囊性疾病的一个少见表现形式,容易和单侧常染色体显性遗传性多囊肾、多房性囊性肿瘤、肾肿瘤囊变混淆CTimagingFig.1A.46-year-oldmanwhopresentedwithmicroscopichematuriaandlowerurinarytractsymptomsattributedtoprostatitis.contrast-enhancedaxialCTscanatlevelofmiddleportionofrightkidneyshowsinvolvementbylocalizedcysticdisease.Notesymmetricexcretionofcontrastmedium.图1A.46岁男性前列腺炎引起镜下血尿和下尿路症状。
增强横轴位CT扫描,对比剂对称性充填,在右肾的中间部分被局灶性囊性病变侵犯CTimagingFig.1B.Sameapatient.CTscanslightlyinferiortoAshowsmultiplesimplecystsseparatedbyattenuatedrenaltissue(arrow).图1B.同一病人,稍低于A图层面CT扫描显示多个单纯囊肿之间被纤细的肾组织分割开(箭头示)。
CTimagingFig.1C.Sameapatient.CTscaninferiortoBhasmoremasslikeappearance.图1C,同一病人,稍低于B图层面CT扫描显示多个囊肿外观Fig.1D.Sameapatient.CTscanoflowerpoleinferiortoCthat,ifviewedinisolation,couldbeconfusedwithcysticneoplasmwithenhancingseptations.Arrowdenotesattenuatedrenaltissue.CTat8-yearfollow-upexamination(notshown)showednochangeinappearanceorsizeofcysts.(CourtesyofGoldNewYork,NY)图1D同一病人,低于C图层面CT扫描,如果孤立的看,容易和囊性肿瘤正在强化的分割混淆。
箭头指示纤细的肾组织。
CT检查随访8年,囊肿的形态和大小没有变化CTimagingCTimagingFig.2A.67-year-oldmanwhowasincidentiallyfoundtohaveleftrenalabnormalitydiagnosedaslocalizedcysticdiseaseofkidney.CTscanobtainednormallyenhancingrenaltissue(arrow)separatedbysimplecysts.图2A.67岁男性,偶然发现左肾异常诊断为左肾囊性病变。
CT扫描肾组织(箭头示)正常强化且被囊肿分割CTimagingFig.2B.Sameapatient.CTscancorrespondingtoAobtained6yearslatershowsradiographicstability.Uninvolvedrightkidneyremainednormal.图2B.同一病人,对应A图6年后CT扫描,左肾病变未见明显变化。
右肾保持正常。
CTimagingFig.2C.Sameapatient.UnenhancedaxialCTscanoflowerpoleofleftkidneyshowsscatteredcalcificationsincystwalls(solidarrows).Regionsofinterest(circled)measure1-10H.Noteincidentalsmallduodenallipoma(openarrow).图2C同一病人,左肾下极平扫横轴位CT显示囊肿壁有散在钙化(实箭头示)。
兴趣区测量为1-10H(环)。
注意附带的十二指肠小脂肪瘤(空箭头示)CTimagingFig.2D.Sameapatient.contrast-enhancedaxialCTscancorrespondingtoCshowsnoenhancementincorrespondingregionsofinterest(circled),whichcontinuetomeasure1-10H.Noteenhancingattenuatedrenaltissue.Calcificationinthecystwallswasnotaprominentfeatureandwasseeninonlyfourcases.(CourtesyofShahH,LittleRock,AR)图2D.同一病人,对应C图的横轴位增强CT显示在相应的感兴趣区没有强化(环),CT值为1-10H。
注意肾组织有纤细强化。
囊肿壁的钙化不是显著的特征,仅4例可见钙化CTimagingFig.3A.50-year-oldmanadmittedforevaluationofsyncopalepisodesandoccasionalright-sidedflankpain.contrast-enhancedaxialCTscanshowscharacteristicfindingsoflocalizedcysticdisease.图3A
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- 肾脏 局灶性囊 性病变