髓质海绵肾结石的计算机断层扫描、静脉肾盂造影表现

doi:10.6040/j.issn.1671-7554.0.2017.955

摘要/Abstract

摘要： 目的结合文献初步探讨髓质海绵肾(MSK)结石的临床表现及影像学和实验室检查结果。方法分析2012年1月至2016年12月间8例MSK患者(包括2岁左右患儿2例、20岁至40岁成年患者3例及40岁至65岁成年患者3例)的临床表现,实验室检查结果和X线平片、静脉肾盂造影( IVP)及计算机断层扫描(CT)表现,分析其影像学成因。结果患儿结石表现不典型,肾集合管可见多发性囊状扩张;20岁至40岁成年患者并发症较少,肾盂轻度积水,肾皮质较厚;40岁至65岁成年患者肾积水明显较重,皮质变薄,可伴有肌酐增高。成年患者CT上可见结石呈铸型,呈现黏膜面光滑而背离面粗糙的“生长征”;合并有细菌感染时,肾盂内可见“气体影征”。CT及X线平片可见肾乳头、髓质区成簇排列的圆形、椭圆形高密度影。IVP显示扩张的集合管和乳突管,可见条形影征和束状征。结论 MSK可合并有肾小管性酸中毒,结石形成多沿黏膜表面走行,表现为平行征、沙粒征、蛋壳样钙化等特点。结石可融合成团,形成沙粒状、团块状,因阻塞致局部积液;合并严重积水时,需碎石解除梗阻以改善肾功能,但乳突管内结石不易清除,术后易复发。

关键词: 髓质海绵肾, 肾结石, 静脉肾盂造影, 计算机断层扫描, 影像学表现

Abstract: Objective To explore the clinical and radiology characteristics and laboratory test results of medullary sponge kidney(MSK). Methods A total of 8 MSK patients, in whom 2 were two years old or so, 3 ranged from twenty to forty years old, and 3 ranged from forty to sixty-five years old, hospitalized in Qilu Hospital from Jan. 2012 to Dec. 2016, were enrolled. The clinical manifestations, laboratory test results, and radiology characteristics, including X-ray, intravenous pyelography(IVP)and computed tomograph(CT), were analyzed. Results Multiple cystic dilatation could be seen in collecting duct of children, but the radiology signs of the kidney stone were not as obvious as the adult. The patients ranged from 20 to 40 years old had less complications and thicker cortex renis; their pelvis were lightly dropsical. The patients ranged from 40 to 65 years old had thinner cortex renis and more serious hydronephrosis, companied with the increased creatinine level. The staghorn stone surface was smooth along the mucosa while the opposite side was rough. The gas density shadow could be seen in pelvis when it was infected with bacteria. CT and X-ray images showed high density shadows with circle and oval signs ranged in carunculae papillaris and inter medulla regions. IVP images showed the ecstatic collecting tubes and papillary ducts with the line and brush shadow. Conclusion MSK 山东大学学报 (医学版)56卷3期 -狄钰,等. 髓质海绵肾结石的计算机断层扫描、静脉肾盂造影表现 \=-can be combined with renal tubular acidosis, drying syndrome. Stone grows along the mucosal surface with the parallel, sand-like, and eggshell calcification signs. Stone can overgrow into the pelvis and calyx, and integrate into clusters, which leads to the local hydrops. Laser lithotripsy is needed to improve the kidney function when the hydrops situation is serious, but the stone in papillary ducts is difficult to remove and easily recurrent after the surgery.

Key words: Medulla sponge kidney, Kidney stone, Intravenous pyelography, Computed tomography, Radiology signs

中图分类号:

R692

狄钰,阎磊,杨飞龙,李大伟,徐忠华. 髓质海绵肾结石的计算机断层扫描、静脉肾盂造影表现[J]. 山东大学学报 (医学版), 2018, 56(3): 60-65.

DI Yu, YAN Lei, YANG Feilong, LI Dawei, XU Zhonghua. Computed tomography and intravenous pyelography signs of medullary sponge kidney stone[J]. Journal of Shandong University (Health Sciences), 2018, 56(3): 60-65.

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