巨大肾血管平滑肌脂肪瘤自发性破裂大出血CT误诊4例分析

CT misdiagnosis of huge renal angiomyolipoma with spontaneous hemorrhage (A report of 4 cases)

目的 :探讨肾血管平滑肌脂肪瘤破裂出血手术前误诊的原因及CT手术前诊断该病的可能性。方法 :复习手术与病理证实的 4例术前CT误诊的巨大的肾血管平滑肌脂肪瘤伴破裂出血的病例。结果 :巨大的肾血管平滑肌脂肪瘤可发生肿瘤内、肾筋膜囊内、盆腔腹膜后甚至腹腔内出血 ;仔细寻找肿块内代表脂肪成分的CT征是支持肾血管平滑肌脂肪瘤诊断的关键。误诊原因可能与出血掩盖肿块内实际存在的脂肪征有关 ,也可能与将被挤到肿块边缘的肿瘤内的脂肪结构误认为肾筋膜囊内或肾窦内的脂肪有关。结论 :巨大的肾血管平滑肌脂肪瘤可发生自发性破裂出血 ,手术前CT发现肿块内脂肪征是诊断的关键。

Objective:To investigate the cause of CT misdiagnosis and possibility of CT diagnosis of renal angiomyolipoma with spontancous hemorrhage before surgery.Methods:CT findings were reviewed in 4 cases with spontaneous hemorrhage secondary to renal angiomyolipoma confirmed by surgery and pathology.Results:Spontaneous hemorrhage secondary to huge renal angiomyolipoma could occur in the tumor,intrarenal fascia,pelvic and retroperitoneal space.The fatty content in the tumor detected by CT was the key to diagnose renal angiomyolipoma.The cause of CT misdiagnosis of renal angiomyolipoma was probably that fatty component was compressed or displaced by mass,and obscured by hemorrhage.Conclusion:Huge renal angiomyolipoma may result in spontaneous hemorrhage.The key to diagnose renal angiomyolipoma before surgery,is to detect fatty attenuation in the tumor on CT scans.