xq dau hieu he tiet nieu
TRANSCRIPT
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Mét sè dÊu hiÖu kinh ®iÓn Mét sè dÊu hiÖu kinh ®iÓn cña C§HA hÖ tiÕt niÖucña C§HA hÖ tiÕt niÖu
Th.S Bïi hoµng tó§H Y H¶i phßng
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DÊu hiÖu cñ gõngDÊu hiÖu cñ gõng-Trªn phim X quang thêng quy : cã h×nh ¶nh cñ gõng hoÆc sõng h¬u (Staghorn), cã thÓ liªn tôc hoÆc ®øt ®o¹n sái thËn
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DÊu hiÖu cñ gõngDÊu hiÖu cñ gõng
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DÊu hiÖu bµn ch©n gÊuDÊu hiÖu bµn ch©n gÊu(Bear paw)(Bear paw)
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DÊu hiÖu bµn ch©n gÊuDÊu hiÖu bµn ch©n gÊu
DÊu hiÖu nµy cho thÊy nhu m« thËn bÞ thay thÕ bëi c¸c ®µi gi·n. Sái ë bÓ, kh«ng g©y gi·n bÓ thËn
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DÊu hiÖu qu¶ mÝt, qu¶ d©uDÊu hiÖu qu¶ mÝt, qu¶ d©u(Jack, Mulberry)(Jack, Mulberry)
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V«i ho¸ nhu m« thËnV«i ho¸ nhu m« thËn(Renal parenchymal calcification)(Renal parenchymal calcification)
Nh÷ng v«i ho¸ ë bªn trong bê ngoµi cña thËn vµ ë vá thËn cã thÓ lµ hËu qu¶ cña ho¹i tö vá thËn, hiÕm h¬n lµ hËu qu¶ cña viªm cÇu thËn, t¨ng oxalat trong níc tiÓu…chóng cã h×nh ¶nh lµ h×nh ®êng ray
V«i ho¸ tuû thËn hay gÆp h¬n, g©y nªn bëi bÖnh thËn xèp (Spongy kidney), acid ho¸ èng thËn, cêng cËn gi¸p.
ThuËt ng÷ “ThËn xèp” ®îc nªu ra ¸p dông víi c¸c èng thËn l¹c chç trong th¸p tuû thËn
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V«i ho¸ nhu m« thËnV«i ho¸ nhu m« thËn
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DÊu hiÖu m¹ng nhÖnDÊu hiÖu m¹ng nhÖn(Cobwebs)(Cobwebs)
§Çu tiªn ®îc ®Æt ra cho tuÇn hoµn bµng hÖ khi t¾c tÜnh m¹ch thËn
HiÖn t¹i thÊy trong nhiÒu bÖnh cã biÓu hiÖn ë khoang quanh thËn
Cã thÓ thÊy nã trong trêng hîp tho¸t dÞch quanh thËn, lµ dÊu hiÖu gi¸n tiÕp cña t¾c nghÏn
BiÓu hiÖn cña nã lµ cã nh÷ng v¸ch trong tæn th¬ng
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DÊu hiÖu m¹ng nhÖnDÊu hiÖu m¹ng nhÖn
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DÊu hiÖu vßng nhu m«DÊu hiÖu vßng nhu m«(Soft-tissue rim sign)(Soft-tissue rim sign)
G©y nªn bëi phï nÒ thµnh niÖu qu¶n do sái Ph©n biÖt víi v«i ho¸ tÜnh m¹ch Cã thÓ kh«ng thÊy trong trêng hîp sái trªn 4mm ë
chç nèi bµng quang niÖu qu¶n
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DÊu hiÖu vßng nhu m«DÊu hiÖu vßng nhu m«
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DÊu hiÖu sao chæiDÊu hiÖu sao chæi(Comet sign)(Comet sign)
§Ó ph©n biÖt víi v«i ho¸ tÜnh m¹ch ë vïng tiÓu khung Lµ dÊu hiÖu trªn CT Kh«ng tin cËy cao b»ng dÊu hiÖu vßng nhu m«
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DÊu hiÖu sao chæiDÊu hiÖu sao chæi
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Mét sè DÊu hiÖu vßng trßn kh¸cMét sè DÊu hiÖu vßng trßn kh¸c(Rim sign)(Rim sign)
Cut-off sign rim sign
(sau 72h)
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DÊu hiÖu vßng trßnDÊu hiÖu vßng trßn
Vßng trßn nghÞch ®¶o trong trêng hîp tôt huyÕt ¸p
PhÝa ngoµi thËn cã vßng gi¶m tû träng h¬n so víi phÝa tuû thËn
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DÊu hiÖu vßng trßnDÊu hiÖu vßng trßn
Vßng trßn ø níc thËn : nhu m« máng vµ cã h×nh lâm qua vÒ phÝa rèn thËn
Pyelo-ureteral junction syndrome
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DÊu hiÖu chÊm trªn chôp thËn thuèc DÊu hiÖu chÊm trªn chôp thËn thuèc (Spotted nephrogram)(Spotted nephrogram)
Nh÷ng vïng nhu m« thËn t¨ng ®Ëm ®é kh«ng ®Òu cã thÓ x¶y ra trªn tæn th¬ng c¸c m¹ch m¸u nhá dÉn ®Õn ho¹i tö m¹ch.
GÆp trong trêng hîp viªm nót quanh ®éng m¹ch, x¬ ho¸ cÇu thËn do t¨ng huyÕt ¸p, x¬ cøng b×.
Cã thÓ thÊy trªn chôp m¹ch, CT vµ MRI
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DÊu hiÖu chÊm trªn chôp thËn thuèc DÊu hiÖu chÊm trªn chôp thËn thuèc (Spotted nephrogram)(Spotted nephrogram)
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DÊu hiÖu lìi liÒmDÊu hiÖu lìi liÒm
Lµ sù xuÊt hiÖn cña thuèc c¶n quang trong c¸c èng gãp, nã song song víi bê thËn hoÆc bê c¸c ®µi gi·n
DÊu hiÖu nµy nã chØ ra chøc n¨ng cña thËn cã thÓ phôc håi dï r»ng cã sù gi·n trÇm träng cña hÖ thèng èng gãp.
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DÊu hiÖu lìi liÒmDÊu hiÖu lìi liÒm
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DÊu hiÖu qu¶ bãng buéc d©yDÊu hiÖu qu¶ bãng buéc d©y(Balloon on a string)(Balloon on a string)
Nã cã h×nh ¶nh nh mét qu¶ bãng lµ bÓ thËn gi·n ®îc buéc bëi d©y lµ niÖu qu¶n.
Nã lµ dÊu hiÖu ®Æc trng cho hÑp chç nèi bÓ thËn-niÖu qu¶n (BÓ thËn h×nh cÇu)
§«i khi cã thÓ ®¸nh gi¸ ®îc sù b¾t chÐo cña m¹ch m¸u so víi niÖu qu¶n.
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DÊu hiÖu qu¶ bãng buéc d©yDÊu hiÖu qu¶ bãng buéc d©y
DÊu hiÖu h×nh liÒm
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ThËn mãng ngùa hoÆc nh÷ng cÇu ThËn mãng ngùa hoÆc nh÷ng cÇu nèi bÊt thêng kh¸cnèi bÊt thêng kh¸c
ThËn ®îc nèi liÒn víi nhau ë mét cùc, lµm thËn quay trôc. Cçu nèi nµy n»m phÝa tríc §MCB. Thêng phèi hîp víi c¸c dÞ tËt kh¸c cña hËu m« trùc trµng, cét sèng, sinh dôc
Mét sè nèi bÊt thêng kh¸c nh cÇu nèi lín cña thËn l¹c chç, thËn ®Üa (Pancake), thËn mói trong tiÓu khung
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ThËn mãng ngùa hoÆc nh÷ng cÇu ThËn mãng ngùa hoÆc nh÷ng cÇu nèi bÊt thêng kh¸cnèi bÊt thêng kh¸c
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Quai ruét ®Õn quai ruét Quai ruét ®Õn quai ruét cña ®¹i trµngcña ®¹i trµng
§¹i trµng ngang tiÕn ®Õn thµnh bông bªn, ®¹i trµng xuèng n»m gi÷a vµ ®æ ®Çy hè thËn t¹o nªn h×nh ¶nh quai ruét ®Õn quai ruét cña ®¹i trµng
DÊu hiÖu nµy chøng tá thËn bÊt s¶n (agenesis) hoÆc l¹c chç (ectopic)
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Quai ruét ®Õn quai ruét Quai ruét ®Õn quai ruét cña ®¹i trµngcña ®¹i trµng
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Quai ruét ®Õn quai ruét Quai ruét ®Õn quai ruét cña ®¹i trµngcña ®¹i trµng
DÊu hiÖu thîng thËn n»m : thîng thËn m¶nh, n»m dµi trong hè thËn chøng tá sù v¾ng mÆt cña thËn
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DÊu hiÖu bíu l¹c ®µDÊu hiÖu bíu l¹c ®µ(lumps, Dromadary)(lumps, Dromadary)
Lµ nh÷ng m« thËn b×nh thêng nhng gi¶ bíu do sù ph¸t triÓn m¹nh cña c¸c cét Bertin
ThËn bÞ c¸c t¹ng l©n cËn ®Ì vµo (hay gÆp lµ l¸ch) gäi lµ thËn Dromadary hump
Ph¸t triÓn lìi tríc vµ sau cña thËn ë vïng rèn thËn CÇn lu ý trêng hîp nµy ®Ó tr¸nh nhÇm lÉn víi khèi u
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DÊu hiÖu bíu l¹c ®µDÊu hiÖu bíu l¹c ®µ(lumps, Dromadary)(lumps, Dromadary)
Dromadary hump
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DÊu hiÖu bíu l¹c ®µDÊu hiÖu bíu l¹c ®µ(lumps, Dromadary)(lumps, Dromadary)
A: ThËn mói bµo thai
B : ThËn bÞ ®Ì (dromadary)
C : Ph× ®¹i trô Bertin
D : Ph× ®¹i lìi tríc vµ sau ë vïng rèn thËn
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ThËn mastic vµ c¸c dÊu hiÖu kh¸c ThËn mastic vµ c¸c dÊu hiÖu kh¸c liªn quan tíi lao thËnliªn quan tíi lao thËn
Giai ®o¹n cuèi cña lao thËn, c¸c nèt v«i ho¸ cã thÓ chiÕm toµn bé bê cña thËn kh«ng chøc n¨ng
Cã thÓ nh×n thÊy v«i ho¸ ë c¸c phÇn kh¸c cña thËn C¸c v«i ho¸ víi h×nh ¶nh bê kh«ng ®Òu, th«
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ThËn mastic vµ c¸c dÊu hiÖu kh¸c ThËn mastic vµ c¸c dÊu hiÖu kh¸c liªn quan tíi lao thËnliªn quan tíi lao thËn
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ThËn mastic vµ c¸c dÊu hiÖu kh¸c ThËn mastic vµ c¸c dÊu hiÖu kh¸c liªn quan tíi lao thËnliªn quan tíi lao thËn
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DÊu hiÖu c¸i ly, cµng t«m hïm, con DÊu hiÖu c¸i ly, cµng t«m hïm, con dÊu (Ball-on-tea, lobster claw, signet dÊu (Ball-on-tea, lobster claw, signet
rim)rim) Lµ nh÷ng h×nh ¶nh trong ho¹i tö nhó thËn Cã thÓ lµ dÊu hiÖu ®µi céng thªm Nguyªn nh©n g©y nªn ho¹i tö nhó thËn : Thuèc gi¶m
®au chèng viªm nonsteroid, thiÕu m¸u tuû thËn do chÊn th¬ng, bÖnh hång cÇu h×nh liÒm, do sö dông thuèc an thÇn, nhiÔm trïng (®Æc biÖt lµ lao), ®¸i ®êng.
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C¸i ly Cµng t«m hïm
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S¬ ®å c¸c dÊu hiÖu cµng t«m hïm vµ c¸i ly
A. B×nh thêng B. Ho¹i tö trung t©m víi dÊu hiÖu c¸i ly
C. Vßm D. Cµng t«m hïm
E. Con dÊu F. §µi h×nh dïi trèng
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B
E
C
E
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DÊu hiÖu ®µi thËn biÕn mÊt DÊu hiÖu ®µi thËn biÕn mÊt (Phantom calix)(Phantom calix)
Xo¸ c¸c phÇn c¬ b¶n cña hÖ thèng èng gãp Nguyªn nh©n g©y nªn tæn th¬ng: t©n s¶n, co th¾t
do chÊn th¬ng, thiÕu m¸u, nh÷ng bÊt thêng ®µi thËn bÈm sinh, ®ông dËp
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Co th¾t ®µi trªn do lao U cùc trªn thËn tr¸i
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ThËn v« danh (Faceless)ThËn v« danh (Faceless)
Lµ dÊu hiÖu trªn CT scanner cña thËn ®«i ThËn v« danh ngô ý chç c¾t ngang qua chç giao
nhau cña hai hÖ thèng bµi xuÊt Më réng cßn lµ dÊu hiÖu xo¸ mét phÇn xoang thËn
trong nh÷ng trêng hîp x©m nhiÔm cña Lymphoma, TCC
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Cã mÆt
Kh«ng cã mÆt
(v« danh-faceless)
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Faceless kidney
Nhu m« thËn b×nh thêng vµ hai niÖu qu¶n
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Faceless kidney-TCC
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DÊU HIÖU CµNH LIÔU (CµNH HUÖ) DÊU HIÖU CµNH LIÔU (CµNH HUÖ) RñRñ
(drooping lily)(drooping lily) Trong trêng hîp t¾c nghÏn ë ®êng bµi xuÊt phÝa
trªn vµ niÖu qu¶n trªn, nã lµm ®æi chç ®µi thËn díi Trong trêng hîp nµy thêng phèi hîp víi thiÕu hôt ®æ
®Çy bµng quang vµ tói ph×nh niÖu qu¶n, l¹c chç c¾m cña niÖu qu¶n trªn vµo bµng quang
Më réng trong trêng hîp khèi cho¸n chç cùc trªn, ®Ì ®Èy ®µi thËn
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Cùc trªn th©n ph¶i bÞ ®Ì
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DÊU HIÖU biÕn d¹ng eo thiÕu n÷ (®æi DÊU HIÖU biÕn d¹ng eo thiÕu n÷ (®æi chç niÖu qu¶n-Ureter deviation)chç niÖu qu¶n-Ureter deviation)
KÐo dµi niÖu qu¶n vµ ®æi chç niÖu qu¶n ®o¹n chç nèi th¾t lng cïng, nã lµm hÑp niÖu qu¶n
X¬ ho¸ sau phóc m¹c cã thÓ gÆp trong nh÷ng trêng hîp rß tiÕt niÖu, sö dông thuèc Ergotamin, chÊn th¬ng ch¶y m¸u sau phóc m¹c, khèi u…
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DÊU HIÖU viªn ®¹n vµ c¸i xá d©yDÊU HIÖU viªn ®¹n vµ c¸i xá d©y(Bullet and bodkin)(Bullet and bodkin)
NiÖu qu¶n gi·n vµ bÞ thu hÑp ®o¹n díi chç t¾c GÆp trong di c¨n cña u l©n cËn, lymphoma, x¬ ho¸
sau phóc m¹c
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DÊu hiÖu cuén catheter (Coiled Catheter)
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Dêu hiÖu ch¹m kh¾c (Stipple)
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DÊU HIÖU ®Çu r¾n hæ mang DÊU HIÖU ®Çu r¾n hæ mang (Cobra head sign)(Cobra head sign)
Gi·n ®Çu xa niÖu qu¶n ®îc bao bäc bëi mét vßng thÊu quang
Hay gÆp trong tói ph×nh niÖu qu¶n (Uretercele) H×nh gi¶ gÆp trong : dÊu hiÖu sau khi sái míi ®i qua
(Vespignali), sái lÊp ®Æc chç nèi niÖu qu¶n bµng quang, u niÖu qu¶n ë lç ®æ vµo bµng quang…
Nõu nghi ngê : chôp Cystography
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Gi¶ tói ph×nh niÖu qu¶n
(TCC) Gi¶ tói ph×nh niÖu qu¶n (sái)
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DÊU HIÖU m× sîi (spaghetti)DÊU HIÖU m× sîi (spaghetti)
Nh÷ng khuyÕt thiÕu thuèc c¶n quang d¹ng sîi trong niÖu qu¶n vµ trong bµng quang, cho thÊy m¸u côc (clot) xuÊt hiÖn
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M¸u côc d¹ng sîi trong niÖu qu¶n tr¸i
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DÊU HIÖU qu¶ lª (pear shaped)DÊU HIÖU qu¶ lª (pear shaped)
Cßn gäi lµ h×nh ¶nh giät lÖ (Tear-drop) Bµng quang cã h×nh kh«ng ®èi xøng bëi qu¸ tr×nh
chÌn tõ ngoµi vµo H×nh gi¶ cã thÓ gÆp trong c¸c trêng hîp cã dÞch
trong khung chËu nh : ch¶y m¸u, ¸p xe, urinoma, lymphocele, h¹ch to kh«ng c©n xøng, ph×nh m¹ch hoÆc tuÇn hoµn bµng hÖ, ph× ®¹i c¬ th¾t lng chËu, nhiÔm mì tiÓu khung CT
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Vì bµng quang ngoµi phóc m¹c
NhiÔm mì tiÓu khung (thÊu quang) vµ BQ h×nh qu¶ lª
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Ph× ®¹i c¬ th¾t lng chËu
G·y khung chËu vµ bµng quang bÞ ®Èy lªn cao (Pie in the sky)
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DÊu hiÖu lç ch×a kho¸ (Keyhole)DÊu hiÖu lç ch×a kho¸ (Keyhole)
H×nh ¶nh gÆp trong trêng hîp van niÖu ®¹o sau. Cã thÓ thÊy trong thêi kú ph«i thai
Bµng quang thµnh dµy vµ gi·n niÖu ®¹o sau do van niÖu ®¹o
ThÊy h×nh ¶nh nµy trªn siªu ©m
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DÊu hiÖu lç kho¸ vµ trµo ngîc trªn bÖnh nh©n cã van niÖu ®¹o sau
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DÊu hiÖu d¶i säc, sîi d©y DÊu hiÖu d¶i säc, sîi d©y (thread or streak)(thread or streak)
DÊu hiÖu nµy ®îc m« t¶ ®Çu tiªn trªn chôp m¹ch ë nh÷ng bÖnh nh©n bÞ t¾c tÜnh m¹ch thËn hoÆc tÜnh m¹ch chñ díi trong trêng hîp RCC
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Chôp m¹ch thËn cã dÊu hiÖu d¶i
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DÊu hiÖu b¸nh xe (Spoked-wheel)DÊu hiÖu b¸nh xe (Spoked-wheel)
§Çu tiªn thÊy trªn chôp m¹ch ë nh÷ng bÖnh nh©n bÞ u tÕ bµo lín (Oncocytome). Nh÷ng m¹ch m¸u tõ trung t©m to¶ ra ngo¹i vi t¹o nªn h×nh b¸nh xe.
Kh«ng ®Æc hiÖu. Cã thÓ gÆp ë c¶ RCC ThÊy c¶ trªn US, CT, MRI : cã h×nh ¶nh sao víi sÑo
trung t©m.
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H×nh chuçi h¹t (string of pearls)H×nh chuçi h¹t (string of pearls)
GÆp trong chôp ®éng m¹ch thËn ë bÖnh nh©n FMD (lo¹n s¶n x¬ m¹ch)
Lµ mét dÊu hiÖu quan träng trong chÈn ®o¸n ®Ó can thiÖp
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MRI
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Xin tr©n träng c¶m ¬n