双侧肾外型肾盂伴左肾盂重度积水99Tcm-DTPA肾动态显像一例

A case of bilateral extrarenal pelvis accompanied with severe hydronephrosis of left pelvis of 99Tcm-DTPA renal dynamic imaging

笔者报道了双侧肾外型肾盂伴左肾盂重度积水^99Tc^m-DTPA肾动态显像一例。肾外型肾盂临床上通常无症状，常为健康体检或其他原因行腹部超声或CT等影像学检查时偶然发现，可伴有肾结石、肾积水等。因肾盂位于肾外，肾盂积水对肾皮质一般无压迫，故患者早期血尿素、血肌酐水平正常或轻度增高。临床为评估分肾功能，将^9Tc^m-DTPA肾动态显像作为首选检查，肾外型肾盂伴一侧肾盂重度积水表现为患侧肾影外异常显像剂浓聚影，需与尿漏、肾旋转不良等鉴别。故笔者通过病例及文献复习加深了对肾外型肾盂伴肾盂积水9Tcm-DTPA肾动态显像特点及鉴别诊断的认识。认识这种解剖变异和提供肾功能相关信息可以帮助临床医师做出决策，并降低术中损伤肾盏肾盂的风险。

The present case describes the 99Tcm-DTPA renal dynamic imaging of bilateral extrarenal pelvis accompanied by severe hydronephrosis of the left pelvis. The extrarenal pelvis is usually asymptomatic and is often found through abdominal examination via abdominal ultrasonography or CT scan. Hydronephrosis generally does not compress the renal cortex because the renal pelvis is located outside the kidney; thus, the patient’s early serum urea and creatinine levels are normal or slightly increased. ^99Tcm-DTPA renal dynamic imaging is the clinicians’ first choice for evaluating left or right renal functions. Bilateral extrarenal pelvis, accompanied by severe hydronephrosis of pelvis, presents an abnormal concentration of ^99Tc^m-DTPA outside the renal area. This abnormality needs to be identified as urinary leakage or renal dysplasia. Therefore, we explored the characteristics of ^99Tc^m-DTPA renal dynamic imaging and the differential diagnosis of extrarenal pelvis with severe hydronephrosis in this study. Understanding this anatomical variation and providing information about renal functions can help clinicians make appropriate clinical decisions and reduce the risk of damage in the renal pelvis during surgery.