腎臟局灶性囊性病變

1、腎臟局灶性囊性病變 IntroductionLocalized cystic disease of the kidney is a benign nonsurgical condition.腎局灶囊性病變是一種良性的非手術(shù)治療的腎臟疾病 Its imaging and clinical features are characterized and differentiated from autosomal dominant polycystic kidney disease, multilocular cystic nephroma, and cystic neoplasm.它的影像學和臨床特

2、征與常染色體顯性遺傳性多囊腎病、多房性囊性腎臟腫瘤、腎臟腫瘤囊變有區(qū)別IntroductionLocalized cystic disease of the kidney has been referred to by a number of different names, including segmental cystic disease of the kidney when it involves just one portion of one kidney, or unilateral cystic disease of the kidney when it involves all

3、 of one kidney.腎臟局灶性囊性病變有不同的名稱，包含腎的階段性囊腫性病變（它累及一個腎的某一部分），或者腎臟的單側(cè)囊性病變（累及一個腎臟的全部）IntroductionIt has also been referred to as “unilateral polycystic disease” . The latter term may be misleading and should be discarded because this lesion bears no relationship to autosomal dominant polycystic kidney dis

4、ease, which is a familial disease with a variety of associated conditions ， none of which are seen in localized cystic disease.它亦指單側(cè)的先天性多囊腎，但后者術(shù)語可能被誤解,應該拋棄,因為這種病變與常染色體顯性遺傳性多囊腎并沒有關系,后者是一個家族性疾病，有各種各樣的相關條件，幾乎沒有一個表現(xiàn)為腎臟局灶性囊性病變。IntroductionLocalized cystic disease was unilateral in all patients and charac

5、terized by multiple cysts of various sizes separated by normal (or atrophic) renal tissue in a conglomerate mass suggestive of cystic neoplasm若病變單側(cè)發(fā)病，在團塊狀腫塊內(nèi)出現(xiàn)不同尺寸的多發(fā)囊腫被正常（或萎縮）的腎組織分隔多提示為囊性腫瘤Clinical presentations included hematuria, flank pain, palpable abdominal mass, and localized cystic disease a

6、s an incidental finding臨床表現(xiàn)包括血尿,腹痛、可觸及的腹部腫塊和偶然發(fā)現(xiàn)局部囊性病變None of the patients had a family history of autosomal dominant polycystic kidney disease.所有的病人均無常染色體顯性遺傳性多囊腎病的家族史Familiarity with localized cystic disease of the kidney and its imaging findings is important to avoid unnecessary surgery and to di

7、fferentiate the disease from autosomal dominant polycystic kidney disease熟悉腎臟的局部囊性疾病和它的影像學表現(xiàn)是重要的,以避免不必要的外科手術(shù)，并且和常染色體顯性遺傳性多囊腎相區(qū)別 IntroductionIntroductionCystic diseases of the kidney encompass a wide spectrum of causes, manifestations, and treatments腎臟囊性病變的病因、臨床表現(xiàn)與治療各不相同Localized cystic disease is an

8、 uncommon presentation of renal cystic disease and has been confused with unilateral autosomal dominant polycystic kidney disease, multilocular cystic nephroma, or cystic neoplasm.腎臟局灶性囊性病變是腎臟囊性疾病的一個少見表現(xiàn)形式，容易和單側(cè)常染色體顯性遺傳性多囊腎、多房性囊性腫瘤、腎腫瘤囊變混淆 CT imagingFig. 1A. 46-year-old man who presented with micros

9、copic hematuria and lower urinary tract symptoms attributed to prostatitis. contrast-enhanced axial CT scan at level of middle portion of right kidney shows involvement by localized cystic disease. Note symmetric excretion of contrast medium. 圖歲男性前列腺炎引起鏡下血尿和下尿路癥狀。增強橫軸位CT掃描，對比劑對稱性充填，在右腎的中間部分被局灶性囊性病變侵

10、犯 CT imagingFig. 1B. Same a patient. CT scan slightly inferior to A shows multiple simple cysts separated by attenuated renal tissue (arrow).圖1 B.同一病人， 稍低于A圖層面CT掃描顯示多個單純囊腫之間被纖細的腎組織分割開(箭頭示)。CT imagingFig. 1C. Same a patient. CT scan inferior to B has more masslike appearance.圖1C,同一病人， 稍低于B圖層面CT掃描顯示多個

11、囊腫外觀Fig. 1D. Same a patient. CT scan of lower pole inferior to C that, if viewed in isolation, could be confused with cystic neoplasm with enhancing septations. Arrow denotes attenuated renal tissue. CT at 8-year follow-up examination (not shown) showed no change in appearance or size of cysts. (Cou

12、rtesy of Gold New York, NY)圖1 D 同一病人， 低于C圖層面CT掃描，如果孤立的看,容易和囊性腫瘤正在強化的分割混淆。箭頭指示纖細的腎組織。CT檢查隨訪8年，囊腫的形態(tài)和大小沒有變化CT imagingCT imagingFig. 2A. 67-year-old man who was incidentially found to have left renal abnormality diagnosed as localized cystic disease of kidney. CT scan obtained normally enhancing renal

13、tissue (arrow) separated by simple cysts.圖歲男性，偶然發(fā)現(xiàn)左腎異常診斷為左腎囊性病變。CT掃描腎組織(箭頭示)正常強化且被囊腫分割CT imagingFig. 2B. Same a patient. CT scan corresponding to A obtained 6 years later shows radiographic stability. Uninvolved right kidney remained normal.圖2B.同一病人，對應A圖6年后CT掃描，左腎病變未見明顯變化。右腎保持正常。CT imagingFig. 2C. S

14、ame a patient. Unenhanced axial CT scan of lower pole of left kidney shows scattered calcifications in cyst walls (solid arrows). Regions of interest (circled) measure 1-10 H. Note incidental small duodenal lipoma (open arrow).圖2C 同一病人,左腎下極平掃橫軸位CT顯示囊腫壁有散在鈣化 (實箭頭示)。興趣區(qū)測量為1-10H（環(huán)）。注意附帶的十二指腸小脂肪瘤 (空箭頭示)

15、CT imagingFig. 2D. Same a patient. contrast-enhanced axial CT scan corresponding to C shows no enhancement in corresponding regions of interest (circled), which continue to measure 1-10 H. Note enhancing attenuated renal tissue. Calcification in the cyst walls was not a prominent feature and was see

16、n in only four cases. (Courtesy of Shah H, Little Rock, AR)圖2D. 同一病人， 對應C圖的橫軸位增強CT顯示在相應的感興趣區(qū)沒有強化（環(huán)），CT值為1-10H。注意腎組織有纖細強化。囊腫壁的鈣化不是顯著的特征，僅4例可見鈣化CT imagingFig. 3A. 50-year-old man admitted for evaluation of syncopal episodes and occasional right-sided flank pain. contrast-enhanced axial CT scan shows c

17、haracteristic findings of localized cystic disease.圖歲男性病人表現(xiàn)為暈厥頻繁發(fā)作和偶然右腰痛。增強軸位CT掃描顯示典型的右腎囊腫。MRI imagingFig. 3B. Same a patient . T2-weighted half-Fourier acquistion single-shot turbo spin-echo (HASTE) axial image corresponding to A shows multiple cysts in right kidney.圖3 B 同一病人， 磁共振半傅里葉采集的T2加權(quán)圖像，顯示A圖

18、相應層面的右腎多發(fā)囊腫MRI imaging Fig. 3C. Same a patient . T2-weighted HASTE coronal image shows involvement of entire kidney by localized cystic disease and single small cyst in left kidney.圖3 同一病人，磁共振T2加權(quán)冠狀位圖像顯示囊腫累及右腎全部，并且左腎有一個小囊腫MRI imagingFig. 3D. Same a patient . MR arteriogram shows slightly attenuated

19、right main renal artery (arrow) with splaying of intrarenal vessels around multiple cysts. Although entire kidney is involved with cysts, there is enough remaining functioning parenchyma so that excretion of contrast medium is present.圖3 D 同一病人，MR動脈血管成像顯示右腎動脈略纖細(箭頭示) ，并且腎內(nèi)血管的分支圍繞在囊腫周圍。盡管整個腎臟被囊腫累及，剩余

20、有功能的腎實質(zhì)足夠排泄目前的對比劑。 Fig. 4. 62-year-old man who was incidentally found to have cystic abnormality of right kidney. CT findings were interpreted as possible cystic neoplasm and patient underwent right nephrectomy. Pathologic evaluation showed findings of localized cystic disease. Although interpreted as possible cystic neoplasm, CT scan viewed with adjacent sections i