肾结核 ppt课件_1.pptVIP

US（结核性肾积脓） 为肾脏重度破坏，肾内淤滞有大量脓液 肾脏外形显著增大，包膜不光滑或凹凸不平 肾盂、肾盏明显扩张，壁增厚，不均匀 无回声区内有云雾状、点状低回声 肾内局部可不规则斑点状强回声，伴弱声影 US（混合型) 见于结核病灶进一步扩大，累积肾髓质和肾盏，形成干酪样坏死和肾盂积水 肾脏增大，包膜凹凸不平 内部回声杂乱，单个或多个低或无回声区，内部有云雾状点状低回声或混杂不规则高回声团块 US (钙化型) 见于肾结核病灶内大量钙盐沉着，致整个肾病变广泛钙化 肾外形不规则，包膜凹凸不平或呈结节状 肾盂、肾盏回声难以显示，取而代之为形态不规则团块状或斑片状强回声，后有明显声影 Differential diagnosis 肾肿瘤 Tumor of kidney 肾囊性病变 Renal cystic disease 慢性肾盂肾炎 Chronic pyelonephritis 肾结核 Differential diagnosis 肾肿瘤 Tumor of kidney 早期均可表现为实质内小高回声团 肾肿瘤为孤立性病灶，球体感明显 CDFI：内部及周边有丰富的或少许血流信号 临床以肉眼无痛性血尿为主 Differential diagnosis Differential diagnosis 慢性肾盂肾炎Chronic pyelonephritis 反复发作的尿路感染为突出临床表现 声像图表现：肾实质内不规则高回声条痕，增强不均匀，与肾窦分界不清。肾结核以实质囊性空洞形成的不规则无回声区和钙化的强回声斑为主 Differential diagnosis 肾囊性病变 Renal cystic disease 当囊肿合并感染、出血时，可能与肾结核混淆 囊壁依然较规则平滑 合并肾盂改变者少见 CDFI示其内及周边均无血流信号 significance 1.超声检查对肾结核的早期诊断未必有很大帮助，一般可根据Ｘ线尿路造影和尿的细菌学检验等作出诊断。但超声对于中～重度肾结核和Ｘ线不显影的重型肾结核颇有诊断价值。 2.不典型的病例，应掌握肾结核的特点，密切结合患者临床病史、症状、实验室及其他影像学检查，对临床诊断和病情判断仍有一定的价值。 LOGO 贺玉芳 卜云芸 Case Report CASE B543332 Female，50-year- old  Presentation: ultrasound revealed an atrophic right kidney with multiple calcifications in a physical examination 1 year ago.  Asymptom X-Ray Her chest radiograph shows old tuberculosis focus in the upper pole of the left lung US The right renal shows irregular contour, poorly defined border and multiple shadowing calcifications consistent with renal tuberculosis and autonephrectomy.  CT small, non-enhanced kidney with multiple calcifications and retroperitoneal cacified lymphs, which consistent with renal TB and autonephrectomy. pathology right renal parenchymal atrophy, interstitial sclerosis, ureteral chronic inflammation and periureteric fibrosis.. suggesting necrotic granulomatous inflammation,consist with tuberculosis. The acid-fast bacilli was negative  Renal tuberculosis Breif Introduction General introduction 1 2 Pa