X QUANG H NIEU

BS. Ho Hoang Phng BM. Chan oan Hnh anh

THAN

Hnh nh hc Y khoa
X quang Siu m CT X quang ct lp in ton MRI Cng hng t DSA Chp mch mu s ha xa nn Y hc ht nhn

DAN BAI

1. Phoi thai hoc Giai phau hoc 2. Khao sat CHA 3. D tat bam sinh 4. Nhiem trung ng tiet nieu 5. Soi ng tiet nieu 6. U ng nieu duc 7. Benh ly nang 8. Chan thng 9. Benh ly noi khoa ng nieu duc

Phoi thai hoc

3 cau truc au tien : tien than, trung than va hau than. - Hau than phat trien t 2 nguon : + mam nieu quan: nieu quan, be than, cac ai than va cac ong thu thap. + khoi nguyen bao hau than. - Than khi au nam vung chau, di chuyen dan len phan cao sau phuc mac.
-

Phoi thai hoc

Phoi thai hoc

Bang quang: - Vach nieu trc trang dnh vao mang o nhp (tuan 7) ngan chia thanh 2 phan : + Xoang nieu duc + Trc trang - Noi vi nieu nang, sau tr thanh si x goi la ong nieu ron.

Giai phau hoc - Than

Dang hat au ( 10 x 5 x 3 cm) Hai mat : trc loi , sau phang Hai b : ngoai loi , trong lom, co khuyet Xoang than trung tam Chieu dai P < T P thap hn T 5 nhanh ong mach phan thuy

Giai phau hoc - Than

Bao x an hoi Nhu mo Vo than : ngoai vi, bao quanh cac tuy, tao thanh cac tru Bertin Tuy than : trung tam, tao thanh cac thap Malpighi Xoang : song song vo bao, cha be than, ong mach, tnh mach, bach huyet, m.

Giai phau hoc - Than

Giai phau hoc Nieu quan

-

Ong dan dai 25 35 cm Khau knh 2 8 mm 3 cho hep sinh l

Giai phau hoc Bang quang

-

Tam giac bang quang : 2 lo nieu quan va lo nieu ao, hang nh ve hnh dang va v tr. 5 lp: + Thanh mac + c doc + c vong + c doc + niem mac

Giai phau hoc Bang quang

Cac KT khao sat bo may tiet nieu va khoang sau phuc mac

KUB , phan biet vi ASP UIV (Urographie intraveineuse) UCR (Urthro-cystographie rtrograde) Sieu am CT (scanner) Angiographie MRI Scintigraphie Nphrostomie, pylographie ...

X quang

KUB UIV UCR UPR Cystographie Nephrostomie Pyelographie

KUB (Kidneys, Ureters, Bladder)

Chun b BN:lm sch bng T th chp:nm nga. Yu cu: ly h niu t cc trn thn n b trn xng mu.
Mc ch: tnh trng chung h niu, tnh trng bng, so snh phim chp UIV.

Phn tch phim

+thn +ng m pha ngoi c tht lng, cnh phc mc +m cn quang bt thng +tnh trng chung bng +bt thng xng( ct sng, khung chu)

Phn bit KUB v ASP

KUB Kho st h niu. Tht tho. Nm nga. Cc trn thn n khp mu.

ASP Kho st bng/ bnh l bng cp. Khng tht tho. Nm hay ng. Vm honh n l bt, thnh bng hai bn.

Thn

V tr: cc trn-thn (T):b trn D11 -thn (P): b di D11

KT thn: L=3,1-4,4 h(L2) + a m B thn Trc thn: song song b ngoi c tht lng.

KUB bnh thng

Bt thng thn

Thay i b thn: u (li), vim mn( co lm) Thay i trc thn: - p: u thn, u sau PM -bm sinh: xoay trc, thn mng nga

Bt thng ng m pha ngoi c tht lng

Mt ng m: u chn p vim nhim.

m cn quang bt thng trn ng i h niu

Si h niu, u, ng vi nhu m thn CPB: si ti mt, vi hch mc treo, vi ha tnh mch.

Tnh trng chung bng

Kh h mt (Nhim trng h mt) Cc quai rut trng kh

Kh trong h mt

Bt thng xng

c xng bt thng (di cn TLT)

KUB

Gan Lach Da day (phnh v) Manh trang C Psoas Than Bang quang

UIV

Urographie intraveineuse Chp h niu cn quang ng tnh mch Mc ch: nh gi tng qut tnh trng h niu gii phu chc nng h niu

Ch nh UIV

Tiu mu Si niu Bnh l nhim trng h niu Bnh l u, kn thn Kho st chc nng, kho st bt thng hnh thi h niu, cc bnh l bm sinh

Chng ch nh UIV

Mt nc CC tng i: suy thn, d ng Iode, a u ty, thai nghn.

Chun b

Nhn i trc chp 3 gi Ung t nc Trnh chp bng c cht cn quang trc 5-7 ngy.

UIV

Tin hnh:
Chp phim KUB ngay trc khi bm thuc. Bm thuc ng tnh mch (liu 1 1,5 ml/kg). Phim sm (ngay tc th sau khi bm thuc) nhu m v ng b thn. Phim th 05 pht i thn, b thn. Phim th 15 pht b thn, niu qun. Phim th 30 pht bng quang.

UIV bnh thng

Tin hnh

Iode: 1-1,5 ml/kg, TTM Cc phim: -KUB -Phim sm:ngay sau tim thuc, nh gi nhu m v ng b thn. -Phim 5 pht: i thn v b thn -Phim 15 pht: b thn v niu qun -Phim 30 pht: bng quang (s lng phim v thi gian chp ty thuc yu cu bnh l v chc nng thn)

Hnh khuyt h niu

i b thn: Si khng cn quang U thn (Hnh chn bm, ng b khng u) niu qun: U niu qun( hnh khuyt gia 2 on dn) Ph nim mc bng quang: Si( ng vin r, di ng) U CPB: bng kh, cc mu ng, chn p t ngoi

Hnh cng h niu

Ti tha i thn Hoi t gai thn Hang: do ph hy nhu mthng vo i thn ng r trong chn thng Ti tha bng quang

D DNG BM SINH

D dng bm sinh thn: +s lng:tha thn, mt thn. +kch thc: thn to, thn nh +v tr:lc ch, xoay thn D dng bm sinh i-b thn: b thn,niu qun i D dng bm sinh niu qun: ng i: vo m o, sau TMCD. khu knh: ln bm sinh, nang niu qun.

Thn lc ch

Thn lc ch

i-b thn i

Ln niu qun

Nang niu qun

Hp khc ni

Ti tha bng quang

SI H NIU

Kch thc, s lng. Tnh cht cn quang Hnh dng: san h, ng tm, hnh gai. V tr. CPB: si ti mt, hch mc treo, vi ha tnh mch.

Soi ng tiet nieu

-

Soi than thng gap, 12% dan so. Gia tang theo tuoi. Tai phat 40 70% Soi gap nhieu nhat la calcium oxalat (60 80%) Nguyen nhan tao soi cha biet ro (70-80%) Mot so yeu to nghi ng (tang calci mau, tang ure mau, nhiem trung, ong, toan hoa ong than, )

Si
Thnh phn T trng
Phosphate de Calcium Oxalate de calcium Phosphate amoniaco magnsien Cystine Acide urique Boue calcique Sulfamides 22g/ml 10,8 g/ml 4,1 g/ml 3,7 g/ml 1,4 g/ml

Hnh dng
Coraliforme b u Muriformes coraliforme Lgrement ramifis, en verre dpoli Rond lisse, radiotransparent Sdimentation Lacunes rgulires

Bnh cnh

Infections, goutte

Goutte, rgime Nphrocalcinose TTT aux sulfamides

Soi ng tiet nieu

Bieu hien lam sang: - Cn au quan than - au lng - Tieu mau - Nhiem trung nieu - Suy than - Khong trieu chng

Soi ng tiet nieu

Vai tro hnh anh hoc: - Khang nh chan oan, xac nh kch thc, v tr, so lng soi va tm bien chng i kem. - Phng tien: + KUB + Sieu am + UIV + CT

iu tr

T khi :
Kch thc
1mm 87% 2-4mm 76% 5-7 mm 60% 7-9 mm 48% >9mm 25%

V tr
NQ gn 48% NQ gia 60% NQ cui 75% Khc ni NQ-BQ 79%

90% si < 4mm t khi !

Coll, AJR 2002; 178:101-103

ng vi tnh mch

Si ti mt

U H NIU

U thn U niu qun U bng quang

U thn

Thn ln khu tr Vi ha c tnh Thn b y lch, xoay trc Xa b c tht lng Thay i hnh dng bnh thng cc i-b thn

U thn

Carcinoma t bo thn chn p i b thn

U niu qun

Carcinoma niu qun li vo lng niu qun, dn niu qun trn v di ch hp.

U bng quang

Hnh khuyt thuc trong lng bng quang, dn h i- b thn, niu qun hai bn.

U ng nieu duc
Carcinoma te bao than (RCC) - Carcinoma te bao chuyen tiep (TCC) - U mach c m(AML:Angiomyolipoma) - Cac loai u khac - Di can RCC: Renal Cell Carcinoma TCC:Transition Cell Carcinoma
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Carcinoma te bao than (RCC)

Lam sang: thng tiem an - Bo ba chan oan: au hong, tieu mau ai the, s c khoi vung than (4-9%) - Trieu chng toan than (13%) : chan an , sut can - Bieu hien th phat do san xuat hormone: tang hong cau, tang calci mau, ha kali, tang tiet sa, tang huyet ap, vu to nam gii - Phat hien tnh c: 40% - Di can en gan nh moi c quan trong c the (hach, phoi, gan, xng, thng than, nao)

Carcinoma te bao chuyen tiep (TCC)

Dch te hoc: - Chiem 7% u than nguyen phat - U than gap 2 3 lan nieu quan - TCC bang quang gap TCC than 50 lan

TCC than
-

Nam : n = 4 : 1 Tuoi trung bnh : 65 Lam sang: + 75% tieu mau (ai the hoac vi the) + 25% au vung hong + < 5% phat hien tnh c

TCC than

TCC nieu quan

-

Hiem gap, 1 6 % cac loai ung th ng tiet nieu tren Nam : n = 3 : 1 Tuoi : 50 70 70 75 % 1/3 di 60% la u nhu 40% u khong nhu

TCC nieu quan

-

Lam sang: tieu mau, tieu nhieu lan, tieu kho va au Hnh anh hoc: + Chup be than ngc dong, UIV : quan sat trc tiep nieu quan + CT: anh gia o lan rong ngoai nieu quan + Sieu am: than trng nc, nieu quan dan, oi khi phat hien khoi ac

TCC bang quang

-

U ac tnh thng gap Nam : n = 3 : 1 Tuoi : 60 70 V tr: tam giac bang quang, doc theo thanh ben va sau. 70% ton thng nong 30% dang xam lan Lam sang: tieu mau thng gap, tieu nhieu, tieu kho, au tren xng mu

La vessie

BNH L NHIM TRNG

Vim thn b thn cp Vim i b thn mn Lao h niu

Vim thn b thn cp

75% Xq bnh thng Thn ln nh H i- b thn yu. nc b thn v on trn niu qun. C th c kh

Vim i b thn mn

Kch thc thn gim Dn i thn do co ko B thn lm do so

Vim i b thn mn

Teo nhu m, dn i thn.

Lao thn

Du gm nhm i thn Vi ha To hang Mt nhu m, so, xon i thn Cht hp i nh, rng khu tr, nc khu tr. Giai on cui thn b ph hy ton b.

Lao thn

Du gm nhm cc i thn di do lao thn

Lao thn

Thn (P): cc di ng vi, gim nhu m.

Lao niu qun

Hp niu qun nhiu ni niu qun cng v ngn.

Lao bng quang

Th tch nh Nim mc khng u Km theo: ln hoc vi TLT, p xe c tht lng

Lao bng quang

Bng quang gim th tch, co rt, niu qun dn do tro ngc.

BNH L CHN THNG

Thn: t mu trong thn, t mu di bao, rch nhu m gy khuyt dng ng hoc thot cht cn quang. Niu qun: thot cht cn quang do t niu qun. Bng quang: v trong phc mac, v ngoi phc mc hoc c hai.

Chn thng bng

Sige Rate Foie Pancras Tube (Grle, D2, D3, colon estomac) Msentre Rein Uretre Surrnale Vessie Urtre Frquence 25% 10% 2-3% (> enfant) 5% 2-3% 10% <1% 1% 2-3% 2-3% Examen de rfrence Scanner Scanner Scanner Scanner, lavage pritonal Scanner, lavage pritonal Scanner

Scanner
Scanner Scanner, cystographie

Urtrographie

Chan thng
-

CT la phng phap chon la au tien, khao sat c nhieu c quan Sieu am giup theo doi bn biet ton thng chan thng nhu mo than

Chn thng cc di thn (T)

t niu qun

V bng quang ngoi phc mc

V bng quang trong phc mc

UCR: nieu ao nam bnh thng

Nphrostomie

CR - COMPUTED RADIOGRAPHY

CR - COMPUTED RADIOGRAPHY

a. u im + Qu trnh to nh n gin, nhanh chng, khng cn phng ti nh Xquang c in. + S dng my in phim kh, n gin v thn thin vi mi trng, khng c hi. + nh thu c di dng s nn c th lu tr, truyn i d dng. + Tm thu nhn nh c th ti s dng nhiu ln (khong 20.000 ln). b. Nhc im + Vn u t ban u rt ln.

DR DIRECT RADIOGRAPHY

DR Digital Radiography

CR Computed Radiography

Cho nh X-Quang s trc tip. Cho nh gin tip sau khi c C th chp lin tc khng cn my Digitizer qut. xa. Khng cn casette, c th ghi Ngoi casette, c thm my tn bnh nhn trc tip. qut, my ghi l lch bnh nhn.

Cho nh ngay sau khi chp.

Chm hn DR v thi gian cho nh (c th n 90 ln)

a nng hn v chp c ni Bn cm ng c nh ch dng khc ri mang v trung tm x c vi 1 my X-Quang. l. L h thng hin i, gn nh. H thng cn nhiu my mc i theo. Chi ph thp hn.

Chi ph cao.

ng dng ?

ng dng lng mn !

ng dng .. Chnh tr ?

Lm..dng k thut cao !

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