往期相关链接：
“肾皮/髓质钙质沉着症”的鉴别诊断
History:A75-year-oldmanwithachronichistoryofmicrohematuriawasreferredforaCTurogrambyhisurologist.
病史：75岁男性，长期镜下血尿，泌尿外科医生建议其行CTU检查。
Scout,coronalprecontrast,axialnephrographic/excretoryphaseimages,andvolume-renderedcoronalreconstructionsoftheleftandrightkidneysareshownbelow.
定位像、冠状平扫、轴位排泄期图像及左、右肾冠状VR重建如下所示。
Additionalhistory:Thepatienthasapriorhistoryofmicrohematuriaandkidneystones.ReviewofthePACSforpriorimagingrevealsanintravenouspyelogram(IVP)from.Scoutandpostcontrastexposuresareshownbelow.
病史补充：患者之前患有镜下血尿及肾结石。回顾PACS中年的静脉尿路造影（IVP）图像，腹部平片及造影后图像图像所示。
Findings影像表现
CTurogram():Noncontrastimagesdemonstratemultiplebilateralnonobstructingrenalcalculi,thelargestmeasuring6mmintherightkidney.Someofthecalcificationscouldrepresentnephrocalcinosis--forexample,thoseintheupperpoleoftherightkidney.Thekidneysshowsymmetricenhancementwithoutsuspiciousrenalmass.Multiplebilateralexophyticsimplerenalcystsarenoted,thelargestinthemidpoleoftherightkidneymeasuring3.6x4.3cm.Thereareadditionalsubcentimeterlow-attenuationlesionsthataretoosmalltocharacterize.Thereisa"paintbrushsign"appearancetotherenalmedullaeinkeepingwithahistoryofmedullaryspongekidney.Thereismildbladderwallthickeningandtrabeculationthatmayberelatedtochronicoutletobstruction.Furtherevaluationisdeferredtocystoscopy.
CTU：CT平扫可见双肾多发非梗阻性肾结石，右肾最大者直径约6mm，其中一些钙化可能代表肾结石，例如，右肾上极的那些。肾脏对称性强化，未见可疑肾肿物。双肾可见多发单纯性肾囊肿，大者位于右肾中部，大小约3.6x4.3cm；另可见不足1cm的低密度灶，其太小而不能显示。肾髓质表现为“毛刷征”，符合髓质海绵肾。膀胱壁轻度增厚并小梁形成，与慢性流出道梗阻有关。进一步评估需膀胱镜检查。
IVP():Preliminaryscoutimagesdemonstrateaclusterofatleastthreeradiopaquestonesintheupperpoleoftherightkidney;thelargesttwostonesinthisclustereachmeasure6mmindiameter.Inaddition,thereareprobableclustersofsmallerstonesintheinterpolarrightkidneyandrightlowerpole.FollowingtheuneventfulintravenousadministrationofmLofnonioniccontrastmaterial,promptnephrogramsdevelop,whichshowthekidneystobenormalinsize,shape,appearance,andinternalarchitecture.Thereisdiffusebilateraltubularectasia.Contrastisexcretedpromptlyintootherwisenormal-appearingpyelocalycealsystems.Thecalculiarenolongerseenandlikeyresideindilatedtubules.Theuretersarenormalincourse,caliber,andappearance.Theurinarybladderhasamildlytrabeculatedappearance.Therearetwosmallurinarybladderdiverticula:oneofthebladderdomeandonearisingfromtheleftlateralbladderwall.Nofillingdefectsareseen.
IVP：预扫定位像可见右肾上极至少3个阳性结石，簇状分布，最大的两个直径约6mm。另右肾中部及下极可见成簇的小结石。静脉注射非离子型对比剂ml，立即摄片，可见肾脏大小、形态、表现及内部结构正常，可见弥漫性双侧肾小管扩张，造影剂进入正常的肾盂肾盏系统。钙化并未显示，可能在扩张的肾小管内。输尿管走行、直径及表现正常，膀胱轻度小梁形成，可见两个小膀胱憩室，一个位于膀胱顶壁，一个位于左侧壁；未见充盈缺损。
Differentialdiagnosis
Medullaryspongekidney
Nephrocalcinosis
Renalcorticalnecrosis
Renalpapillarynecrosis
Renaltuberculosis
Oxalosis
Renalpyramid"blush":Normalhomogeneousenhancementofpyramidswithnotubulardilation
鉴别诊断：
髓质海绵肾
肾结石
肾皮质坏死
肾乳头坏死
肾结核
草酸盐沉着症
肾锥体充盈：肾锥体正常均匀强化，无肾小管扩张
Diagnosis:Medullaryspongekidney
最后诊断：髓质海绵肾
KeypointsMedullaryspongekidney(MSK)
Pathophysiology
Medullaryspongekidneyreferstoasporadicconditioninwhichthemedullaryandpapillaryportionsofthecollectingductsaredysplasticanddilatedand,inmostcases,developmedullarynephrocalcinosis.Occasionally,itcanbehereditary.
Patientsarepredisposedforurinarystasisandresultingurolithiasis.
Asmanyas33%to50%ofpatientshavehypercalcemia(i.e.,hyperparathyroidism).
Theetiologyandpathogenesisareunknown.
Oncrosssection,thekidneyappearsasaspongeandtherearemultiplecysticcavitiesintherenalpyramids.
Cystscontainyellow-brownfluidanddesquamatedcellsorcalcifiedmaterial.
Calculiwithincystsandtheirwallsconsistofcalciumoxalate±calciumphosphate.
Thesizeandnumberofrenalcalcificationstypicallyincreasewithtime.
Theconditionmaybebilateral(75%)orunilateral(5%),anditmayinvolveasinglepyramidorsegment.
TheprognosiswithMSKisgenerallygoodandpatientswilltypicallyleadanormallifeunless早期白癜风治疗方法皮肤白癜风的治疗方法有哪些
