2009-12-22髓质海绵肾.ppt

ultrasound calcification pathology Diagnose Radiological diagnosis Clinical history Task of radiology Diagnosis evaluation of growth in size or increase in number of these microliths Differentiation Nephrocalcinosis Tuberculosis of kidney Nephrolithiasis Renal papillary necrosis treatment General treatment drinking Treatment of complication 发生在肾髓质的先天性良性病变； 主要特征为肾髓质集合管和锥体部的乳头管呈梭形扩张或小囊性扩张 * * 具有遗传倾向;可与caroli’s并、偏身肥大、先天性巨输尿管、马蹄肾、马凡氏综合征等伴发;发病率较低;多无症状;有症状常出现于30-40岁（也有报道是40-50) * E-D综合征：先天性结缔组织发育不全综合征 Wilm 肿瘤：肾母细胞瘤 肾动脉纤维肌性发育不良 多数患者因集合管的扩张尿潴留造成的感染、络石等并发症引题腹痛和血尿等临床症状就诊。该病可引起肾浓缩功能下降，严重发复感染致肾盂肾炎或集合管内维石穿透囊璧，或经扩大的乳头管进入肾溢形成肾结石，造成尿路梗阻引起肾功能逐渐下降 * X线平片表现为双肾轮廓清晰或隐约可见。肾影均不大。肾乳头区可见多发斑点状钙质样致密影，呈簇状分布．成扇形排列，边缘较清楚，大小约2mm～8mm * The collecting tubules are dilated, producing a blush-like appearance. There is bilateral cortical loss. Dense calcifications are present bilaterally within distended collecting tubules.肾盂肾盏形态正常。IVP显示病变局限于肾锥体内．造影剂充填扩张的集合管并包绕其内的小结石，使肾锥体内呈现由肾盏向外的刷子状、花蕾状或花朵状致密影。皮质不受累及，肾盂、肾盏形态正常，肾功能常正常  * reveals collection of the contrast agent in the ectatic renal collecting tubule in the renal pyramids (arrows) and linear striations of contrast material that opacifies the collecting tubule, giving a paintbrush-like appearance (arrowheads) radiating outward from the calyces * Representative images from the first phase of a multidetector-row computed tomographic urogram show bilateral nonobstructing intrarenal calculi (arrows). Similar-sized calculi could be seen scattered throughout both kidneys. * * characteristic papillary blush (arrows) associated with scattered calculi within the dilated collecting tubules. The computed tomographic demonstration is equivalent to the well-documented intravenous pyelography findings. * 髓质海绵肾结石B超图的特点是，肾髓质区原呈锥形的肾乳头低回声区消失，代之以大小不等、互不相通而呈圆形或类圆形、放射状分布的无回声区，其最大直径不超过1厘米。无回声区内可见大小不等、形态不规则的强回声光点，最大直径小于0.6厘米，其后方伴有细小而清晰的声影，少数声影不典型。 * 病变累及多个肾锥体。肾脏边缘光滑。剖面见锥体旱多孔状或海绵状，小囊腔多数为1—6 mm，50％～90％囊内含有多发性小结石，有淡黄色液体，晚期这些小囊腔町增大，锥体也显著增大。并发感染者，肾问质