女性,66岁, 右侧腰痛伴间断性肉眼血尿10余天

2019-09-19 不详 影像园

右侧腰痛伴间断性肉眼血尿10余天,疼痛为阵发性,可自行缓解,疼痛发作时有发热

【所属科室】

泌尿外科

【基本资料】

女性,66岁。

【主诉】

右侧腰痛伴间断性肉眼血尿10余天,疼痛为阵发性,可自行缓解,疼痛发作时有发热

【查体】

36.5度,余无明显异常。

【辅助检查】

B超:右肾占位

【影像图片】









【讨论】

评论:平扫右肾实质内可见一类圆形稍低密度影,密度均匀,与肾组织边界欠清。增强扫描后肾实质明显强化,肿块边缘强化,囊壁稍显增厚。尿路造影片示右侧肾盂肾盏受压改变。
 
【病理结果】

手术病理:右肾炎性假瘤(直径3cm),周围肾间质慢性炎症
 
【病例小结】

肾脏炎性假瘤可发生于任何年龄,以40岁以下者居多,男女发病无明显差别。患者多有低热、腰痛、肾区不适或有疼痛、扣痛等,部分病人有血尿、脓尿,通常无尿路刺激症状。本病的病程可以自数天到数年,预后良好。1、CT表现:

1)平扫肿块呈类圆形或不规则形,直径一般为2~5mm,密度与肾实质密度大致相似,边界不清,CT值20~40HU。2)增强扫描实质期病灶实质部分轻度强化,边缘部分可呈较明显环形强化。3)患侧肾筋膜增厚,可有肾周模糊。2、与肾癌鉴别:早期肾癌(尤其 <3 cm 的小肾癌) ,因肾细胞癌大多血供丰富, 增强扫描的皮质期明显强化,实质期瘤体强化迅速减弱。而炎性假瘤血供较少。3、本例特点:1)平扫病灶略低于肾实质

2)增强边界清楚,周边略呈环形强化。病灶为类圆形,实质部分密度均匀,强化不明显。

3)右肾前筋膜稍增厚

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    2020-05-26 Homburg
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    2019-10-07 TZF0811
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    2019-09-21 quxin068