培训资料--急腹症CT诊断-腹部外伤.ppt

2013-10-22 腹腔游离气体 盆腔积液 局部肠壁增厚 2013-10-22 * 肾脏损伤 单独损伤少见，通常是复合性损伤的一部分 多为钝伤 患病或异常的肾脏，较正常肾脏更易损伤 （轻微外伤即可能积水肾盂破裂，感染脆弱肾脏碎裂，异位肾、马蹄肾碎裂；外伤较轻，损伤严重时，考虑到基础肾脏病变的可能） 儿童较成人更易发生肾脏损伤（外缘分叶、肾脏相对身体体积大） CT首选检查，明确肾脏损伤的类型和范围 2013-10-22 分类 2013-10-22 Michael Federle将肾损伤分为四类： 轻度损伤：（75-85%） 肾挫伤 肾和包膜下血肿 不涉及收集系统或髓质的小挫裂伤 小段梗死 中度损伤：（10%） 涉及髓质或收集系统的挫裂伤 节段性梗塞 重度损伤：（5%） 肾碎裂 肾梗死 收集系统破裂 CT改变 肾挫伤，最轻的肾损伤，平扫表现为弥漫性或局限性的肾肿胀，含有点状高密度新鲜出血，增强扫描延迟强化或强化程度降低，常伴有包膜下和肾周出血 肾裂伤，正常强化实质内线状无强化区，常伴有包膜下和肾周出血 肾碎裂，多发线状无强化区，分隔开强化或不强化的肾脏碎片，常撕裂肾段血管，伴有大的肾周血肿 肾蒂损伤，肾梗死或肾淤血性改变（肾脏增大，皮质患者强化，肾静脉内发现血栓可确诊） 集合系统损伤，含对比剂尿液外溢（延迟扫描时间足够长） 2013-10-22 2013-10-22 Renal contusion. Computed tomography image demonstrates a focal area of low attenuation in the posterior aspect of the left kidney representing renal contusion (arrows) 左肾挫伤 右肾裂伤，左肾挫伤 Renal laceration. Computed tomography image at the level of the renal veins demonstrates an irregular, linear, low-attenuation renal laceration (arrow) extending from the right renal hilum to the renal capsule. A left renal contusion (arrowheads) is also present. The hemoperitoneum was related to concomitant splenic injury 2013-10-22 侧面刀刺穿透伤患者 小的肾包膜血肿及肾周积血 左肾包膜下血肿 非膨胀 2013-10-22 Renal fracture. A: Contrast-enhanced computed tomography scan demonstrates fractured left lower renal pole (K) with large perirenal hematoma (H). B: Delayed scan shows extravasation of opacified urine into the perirenal space (arrow). 左肾破裂 对比剂外溢 Renal laceration with perirenal hematoma. Contrast-enhanced computed tomography scan demonstrates a right renal laceration (thick arrow) with associated perirenal hematoma confined by the posterior renal (Gerota's) fascia (thin arrow). The patient also has intraperitoneal blood (H) from a ruptured spleen 右肾裂伤 2013-10-22 Shattered kidney with large perirenal hematoma. Active bleeding is noted in the left perirenal space anteriorly (straight arrows). Small liver laceration (curved arrow) and blood in the hepatorenal fossa are also evident 左肾碎裂 Renal pedicle injury with devascularization