肾血管平滑肌脂肪瘤自发性出血的CT诊断

CT Diagnosis of Renal Angiomyolipoma Spontaneous Hemorrhage

目的：探讨肾血管平滑肌脂肪瘤（AML）自发性出血的CT征象及诊断价值。方法：搜集经手术病理证实的肾AML并发出血10例，分析其CT表现。结果：全部病例均为多脂肪型，右肾6例，左肾4例，肿瘤直径8．5～25．0cm，均有不同程度肾实质破坏。其中急性出血8例，肿瘤内出血表现为瘤体内片状或地图样高密度区，肾周血肿显示片带状软组织密度环绕在肿瘤和肾脏周围或脂肪密度混杂在软组织中，肾旁出血表现为血液在腹膜后间隙广泛延伸，慢性腹膜后血肿2例，表现为较大的混杂密度团块增强后包膜中度强化。结论：自发性出血是肾AML常见而严重的并发症，CT是诊断本病最好的影像学检查方法之一，能明确出血部位、范围，估计出血量和肾组织破坏程度，为临床诊断和治疗提供有价值的信息。

Objective： To evaluate the CT characteristics of renal angiomyolipoma spontaneous hemorrhage and the diagnostic value of CT. Methods： 10 cases with renal angiomyolipoma spontaneous hemorrhage proved by surgery and pathology were collected with their CT appearance being analyzed. Results： All cases belonged to tumors rich in fat,6 cases in the right kidney,4 cases in the left kidney. The tumor size ranged from 8.5 cm to 25.0 cm in diameter,with different degrees of destruction in the renal parenchyma. Among them acute hemorrhage in 8 cases,intratumoral bleeding showed map-like area of high density within the tumor on precontrast CT, perirenal hemorrhage showed soft tissue density strands surrounding the tumor and the kidney or fatty attenuation intermingling with soft tissues,and pararenal hemorrhage showed bleeding ex- tending into the retroperitoneal space; chronic hematoma in 2 cases showed a large inhomogeneous mass and postcontrast CT showed moderate enhancement of the capsule. Conclusion： Spontaneous hemorrhage is a severe complication of renal angiomyolipom. CT is the best imaging method to demonstrate its location and extension, and to evaluate the volume of bleeding and degree of destruction in the renal parenchyma. It provides valuable information for clinical diagnosis and treatment.