肾上腺表皮样囊肿一例

患者女,56 岁,因"体检发现左侧肾上腺占位1 个月余"入 河北省人民医院,无明显临床症状.查体:一般状况良好. 影像表现:超声示左肾后方可探及一低回声团,大小约 4.4 cm×4.0 cm×3.4 cm,边界欠清,内回声欠均.彩色多普 勒及能量图:左肾后方低回声团未见明显血流信号.MRI 示 T1WI (图1A)呈高低混杂信号,病变于T1WI 反相位较同相位信 号未见明显变化(图1B),T2WI 呈混杂稍高信号(图1C),扩散加 权成像(diffusion weighted imaging,DWI)呈不均匀高信号 (图1D),增强扫描病灶内部强化不明显,包膜可见轻度延迟强 化( 图1E).CT 示左侧腹膜后区可见团块状稍低密度影 (图1F),大小约4.2 cm×3.9 cm×4.0 cm,密度欠均匀,病变 内可见散在小点片状脂肪密度影,形态欠规则,局部可见两处 类圆形脂肪密度影突起,边缘可见斑点状钙化,病变与左侧肾 上腺外侧肢分界欠清,增强扫描未见明显强化(图1G).     

幼儿后肾腺瘤超声表现1例

患儿男,3岁.无明显诱因下出现发热伴腹痛4d.临床拟诊:肠系膜淋巴结炎?常规超声检查:肝、胆囊、胰腺、脾、右肾、膀胱末见异常,右下腹及中腹部肠系膜区、肝门部、腹膜后大血管旁、肾门医未见明显肿大淋巴结.左肾大小正常,局部形态失常,下极腹侧面被膜限局性膨降,皮质外缘见一中低回声结节,大小2.0 cm×2.0 cm×1.5 cm,边界欠清,似椭圆形,内回声欠均匀,周边可见少许缝隙状无回声区(图1).高频超声(线阵探头,7.0～10MHz)检查见结节有包膜,大部分边界清楚,仅与肾皮质相接区分界不清,内以实性中等回声为主,下后部近边缘区无回声呈“残月”状,彩色多普勒血流显像(CDFI)检测实性区可见少许条状血流信号(图2)超声诊断:左肾下极皮质源混合性占位(隆起于被膜下),考虑原发肿瘤可能.MRI检查:紧贴左肾下极外侧缘可见一圆形异常混杂信号影,边界清晰、光整,T1WI呈低信号,T2WI、STIR均为高信号,增强后与左肾实质同步强化.后腹膜未见异常信号影.MRI诊断:左肾下极外侧缘占位.CT检查:左肾下极腹侧可见一略低于周围正常肾实质密度的肿块影,大小2.0cm×1.5cm,局部与肾实质分界不清,内部密度不均,增强后呈不均匀强化.CT诊断:     

肾盂黏膜下海绵状血管瘤误诊一例并文献复习

患者女,45 岁,因肉眼血尿两天就诊于济宁市第一人民医院.体格检查:双肾区平坦,左肾区叩击痛阳性.尿常规:尿潜血3+.超声显示左肾集合部中等回声团块.MRI 平扫,左肾中下极见一不规则分叶状团块影,周围肾窦脂肪受压移位,最大截面积约4.1 cm×4.7 cm,边界欠清,T1WI 呈低信号,T2WI 呈高低混杂信号,扩散加权成像(diffusion weightedimaging,DWI) (b=800 s/mm2)呈高信号,相应ADC 值减低,三期增强扫描,病变呈轻度延迟强化,病灶周围肾皮质强化程度较正常肾皮质减低(图1A～1F).     

MRI诊断左小腿促结缔组织增生性小圆细胞肿瘤一例

<正>患者女,27岁,发现左小腿渐进性增大肿物1个月余入院。于入院前1个月患者无明显诱因出现左小腿外侧肿痛,站立时间较长、行走久时症状明显,无低热、盗汗、夜重昼轻等不适,与天气变化无关,仍可行走及锻炼。MRI检查:左小腿上段偏外侧软组织可见不规则分叶状软组织肿块,T1WI呈稍低信号(图1A),T2WI呈混杂低信号,内部见斑点状稍高信号(图1B),T2脂肪抑制相肿块呈混杂信号(图1C),范围约4.3 cm×     

鞍旁脑膜血管周细胞瘤1例

病例 女,46岁.双眼视物模糊2月余,时有头痛、头晕,无恶心、呕吐,无心慌、胸闷,无抽搐发作,无肢体功能障碍,无多饮多尿.化验室检查均为阴性. 影像学表现:CT平扫(图1)示左侧鞍旁分叶状高密度影,大小约4.8 cm×5.6 cm,无钙化,CT值50 HU,注射对比剂后明显强化,动脉期CT值136～240 HU,病灶与左侧海绵窦分界不清,左侧中脑受压.MR示左侧鞍旁不规则团块影,T1WI呈等、低混杂信号,T2WI呈等、高、低混杂信号(图2),增强后病灶显著均匀强化、内见穿支血管(图3),肿瘤占位效应明显.颅内C TA示左侧鞍旁占位病变,血供丰富,可见瘤内血管影,左侧大脑中动脉、大脑后动脉受压移位.     

乳腺假血管瘤样间质增生MRI表现1例

患者女,36岁,发现左乳肿物半年,逐渐增大2个月入院。查体:左乳外下象限触及一大小约6.0cm×4.0cm肿物,质硬,边界清,活动度可,表面皮肤光滑,未见"橘皮样"改变。超声:左乳囊实性占位,BI-RADS 3类。乳腺MRI:左乳外下象限团块,边界清楚,约6.8cm×6.0cm×5.5cm,FSPGR呈等信号,内见裂隙样低信号区(图1A);脂肪抑制T2WI上呈结节状、片状稍高信号,内见裂隙样高信号     

幕下小脑神经节细胞胶质瘤合并幕上弥漫性胶质瘤1例北大核心CSCD

患儿男,13岁,头部左侧阵发性疼痛3月余,视物模糊伴听力减退2个月;既往体健。查体:左上肢指鼻试验、左下肢跟膝胫试验欠稳准。实验室检查未见明显异常。颅脑MRI:右侧额叶皮质下见0.5 cm×0.6 cm点片状T2WI/液体衰减反转恢复(fluid attenuated inversion recovery,FLAIR)高信号(图1A);左侧颅后窝见4.7 cm×5.1 cm团块状异常混杂信号,与小脑分界不清,T1WI呈等或稍低信号(图1B)。     

MRI诊断胫骨血管瘤1例

患者女,43岁。左小腿反复胀痛1个月。1个月前无明显诱因左小腿胀痛,与行走无关,无夜间痛、无活动障碍,且反复发作。曾有左踝扭伤史。体检及专科检查未见异常。X线平片:左胫骨中段骨髓腔见长椭圆形稍低密度区,边缘锐利,未见硬化缘。CT检查:左胫骨中段骨髓腔见一3.0cm×1.5cm大小软组织密度影,密度均匀,边界光整,邻近骨皮质受压变薄,呈弧形压迹(图1)。MR检查:左胫骨中段骨髓腔内见1.2cm×1.2cm×3.5cm大小异常信号,T1WI呈与肌肉类似低信号(图2),T2WI呈明显高信号,其内见不规则线状低信号(图3),边界清楚;增强T1WI病变明显持续不均匀强化(…     

Von Hippel-Lindau综合征2例报告并文献复习

病例 例1,女,30岁.3年前外院诊断"胰头癌、双肾癌",未治疗,无特殊不适,于2013年2月28日来我院就诊.查体:神清,颈软,呼吸音清,右腹触及一巨块,无痛,质软.肝肋下一横指.患者曾生育1子,体健.其父患脑瘤术后死亡,姑姑患胰腺肿瘤,在世.其母体健. CT平扫:胰头部巨大肿块,大小约95 mm×81 mm,密度不均,边界不清,胰腺体尾部增大,呈蜂窝状囊泡改变,最大囊直径约16 mm.双肾多发占位灶(图1a).MRI平扫:头颅MRI未见明显异常.胰头部一巨大肿块,信号不均,T1WI呈低、等信号,T2WI高信号,边界尚清,大小约141 mm×106 mm×100 mm.胰腺体尾部呈弥漫性蜂窝状改变,信号为T1WI低T2WI高.双肾多发小圆形囊灶,直径5～15 mm不等.右肾中部及左肾下部各见一实质性肿物,右侧约35 mm×26 mm,左侧约25 mm×24 mm,T2WI混杂高信号、T1WI混杂等低信号.     

子宫直肠陷凹恶性外周神经鞘瘤1例

患者女,46岁,下腹隐痛伴尿频、尿急及肛门坠胀感10天。查体:子宫后方触及直径6.0 cm包块,表面结节感,压痛明显,活动度差。经阴道超声:阴道与直肠肛管间5.8 cm×4.8 cm囊实性肿物,紧邻宫颈后壁及阴道后壁,以实性中等回声为主;CDFI见其内星点状血流信号(图1A)。腹部MRI:直肠右前方5.6 cm×6.8 cm×5.7 cm囊实性肿物,以囊性为主,与子宫颈后壁分界不清,内见条状分隔及斑片状实性成分,T1WI以低信号为主,T2WI呈等-高混杂信号,DWI呈高信号,增强后实性成分明显强化,囊性成分未见明显强化(图1B、1C);考虑子宫颈后壁肿瘤。     

Ruptured renal angiomyolipoma presenting as renal colic

The case of a patient with acute onset of flank pain and hematuria is presented. Initial therapy was directed toward relief of pain believed to be caused by renal colic. It was not until the patient developed atypical features that the true diagnosis, ruptured renal angiomyolipoma, was discovered. The case and discussion emphasize the need to carefully consider a complete differential diagnosis when evaluating patients with flank pain and hematuria who have atypical clinical features or an atypical course.     

Functional renal imaging: nonvascular renal disease

Functional renal imaging—a fast-growing field of MR-imaging—applies different sequence types to gather information about the kidneys other than morphology and angiography. This update article presents the current status of different functional imaging approaches and presents current and potential clinical applications. Apart from conventional in-phase and opposed-phase imaging, which already yields information about the tiusse composition, BOLD (blood-oxygenation level dependent) sequences, DWI (diffusion-weighted imaging) sequences, perfusion measurements, and dedicated contrast agents are used.     

Cortical renal leiomyoma with extension to renal pelvis

We describe a case of renal leiomyoma in a 21-year-old woman who presented with flank pain and hematuria. Urographic and computed tomographic (CT) studies revealed a large right renal mass with polypoid outgrowth protruding into the renal pelvis. Cortical renal leiomyoma with this radiographic manifestation is extremely rare.     

急性肾功能损伤与衰竭生物标志物

急性肾功能损伤（ARI）与急性肾功能衰竭（ARF）是加强医疗病房（ICU）的常见疾病．ICU中80％的ARF由急性肾小管损伤所致，而非肾小球或间质性病变引起。其死亡率较高，寻找敏感性和特异性较好的ARI或ARF生物标志物，对早期诊断、治疗和改善预后有着重要意义。本文介绍和评估了ARI或 ARF生物标志物的研究现状。并展望了其未来的前景。[第一段]     

Biomarkers of acute renal injury and renal failure

Acute renal failure (ARF) is a frequent problem in the intensive care unit and is associated with a high mortality. Early recognition could help clinical management, but current indices lack sufficient predictive value for ARF. Therefore, there might be a need for biomarkers in detecting renal tubular injury and/or dysfunction at an early stage before a decline in glomerular filtration rate is noted by an increased serum creatinine. A MEDLINE/PubMed search was performed, including all articles about biomarkers for ARF. All publication types, human and animal studies, or subsets were searched in English language. An extraction of relevant articles was made for the purpose of this narrative review. These biomarkers include tubular enzymes (alpha- and pi-glutathione S-transferase, N-acetyl-glucosaminidase, alkaline phosphatase, gamma-glutamyl transpeptidase, Ala-(Leu-Gly)-aminopeptidase, and fructose-1,6-biphosphatase), low-molecular weight urinary proteins (alpha1- and beta2-microglobulin, retinol-binding protein, adenosine deaminase-binding protein, and cystatin C), Na+/H+ exchanger, neutrophil gelatinase-associated lipocalin, cysteine-rich protein 61, kidney injury molecule 1, urinary interleukins/adhesion molecules, and markers of glomerular filtration such as proatrial natriuretic peptide (1-98) and cystatin C. These biomarkers, detected in urine or serum shortly after tubular injury, have been suggested to contribute to prediction of ARF and need for renal replacement therapy. However, excretion of these biomarkers may also increase after reversible and mild dysfunction and may not necessarily be associated with persistent or irreversible damage. Large prospective studies in human are needed to demonstrate an improved outcome of biomarker-driven management of the patient at risk for ARF.     

Epidemiology of renal recovery after acute renal failure

PURPOSE OF REVIEW: Recovery of renal function after acute renal failure is an important clinical determinant of patient morbidity. Herein, the epidemiology of renal recovery after acute renal failure will be described, along with potential predictive factors and interventions. RECENT FINDINGS: Renal recovery has been variably defined, most often as recovery to independence from renal replacement therapy. A recent consensus definition for acute renal failure has been published and included provisions for defining renal recovery. Renal recovery to renal replacement therapy independence occurs in the majority by hospital discharge and peaks by 90 days. All of older age, female sex, co-morbid illnesses, especially chronic kidney disease, and late initiation of renal replacement therapy or conventional intermittent renal replacement therapy have been coupled with non-recovery. Analysis of the literature suggests several interventions may influence recovery. SUMMARY: The prognosis is generally good for recovery after acute renal failure. Most patients will be independent of renal replacement therapy by 90 days. Additional research is necessary, however, to understand recovery rates not only to independence from renal replacement therapy, but also to complete and partial recovery. Future studies need to consider the health economic implications for survival and non-recovery. Finally, questions on the role of various interventions require characterization in randomized controlled trials to determine how they may influence renal prognosis.     

Cardiac enzymes, renal failure and renal transplantation

Diagnostic accuracy of the currently available serum markers of cardiac injury, such as myoglobin, creatine kinase and its myocardial isoform, are altered in patients with renal failure. It is shown that cardiac troponins have decreased diagnostic sensitivity and specificity in patients receiving renal replacement therapy. Data regarding serum levels of these cardiac biomarkers, especially those of the cardiac troponins, in patients with a transplanted kidney are limited. Current data show that levels of cardiac troponin I are unaltered in patients who have undergone renal transplantation, while levels of cardiac troponin T may be elevated.We believe that cardiac troponin I should be the biomarker of choice for diagnosis of myocardial injury in these patients. However, further trials are required for conclusive results.     

Normal left renal vein mimicking left renal artery aneurysm

On transverse ultrasound scans a small number of patients with a paucity of retroperitoneal fat show an initial false impression of a left renal artery aneurysm due to the confluence of two normal findings. The left renal vein is unusually prominent from the hilum of the left kidney to the area between the superior mesenteric artery and the aorta; and part of the normal aortic wall, adjacent to the left renal vein, is incompletely imaged. Explanations for the prominence in the left renal vein and the partial visualization of the aortic wall are discussed, and various maneuvers that allow for accurate identification of both are described. The use of this analysis should prevent the incorrect diagnosis of a left renal artery aneurysm, which might lead to more invasive diagnostic procedures.     

支架植入术治疗肾血管性高血压的中远期疗效

目的:评价肾动脉内支架植入术(PTRAS)治疗肾血管性高血压的中远期疗效。方法:对42例肾血管性高血压(动脉粥样硬化性肾动脉狭窄21例,静止性大动脉炎肾动脉狭窄18例,肌纤维发育不良肾动脉狭窄3例),成功的施行PTRAS治疗肾动脉狭窄,采用彩色多普勒超声、CTA、定期门诊检查及肾动脉造影随访12～60月。全部病例均根据临床血压进行疗效评价。结果:支架植入术技术成功率100%。近期疗效(≤3月):42例患者高血压治愈者24例(57.14%)、改善者13例(30.95%)、无效者5例(11.90%)。中期疗效(4～12月):42例患者高血压治愈者17例(40.5%)、改善者19例(45.2%)、无效者6例(14.3%)。远期疗效(≥13月):42例患者高血压治愈者16例(38.1%)、改善者17例(40.5%)、无效者9例(21.4%)。≥3年疗效:24例高血压患者治愈者16例、改善者6例、2例无效。随访中有10例发生支架内再狭窄,行经皮腔内肾动脉成形术(PTRA)后,有6例血压改善。结论:PTRAS治疗肾血管性高血压中远期临床疗效肯定,支架内再次狭窄,大部分病例行PTRA可取得满意的疗效。