CHUP HE NIEU CAN QUANG NG TNH MACH

BS. PHAM TUAN MINH TS.BS. PHAM NGOC HOA

 phap c ban e khao sat he nieu. nieu.  Cac phng phap khac (C.T (C. scan, M.R.I, xa hnh, chup mach mau...) mau...) c dung khi co van e nghi ng. ng.  U.I.V. giup: giup:  Khao sat tng oi nhu

KHAI QUAT Chup U.I.V la phng

CH NH

Nhng bieu hien benh ly cua he nieu. nieu.

Nhng bieu hien benh ly

chung: chung: sot CRNN, thieu mau

Nhng benh co kha nang

buoc la mat nc, acbiet than trong benh nhan tieu ng co suy than. than. Cac trng hp ac biet: biet:  Suy than. than.  Khong dung nap Iod: Iod:  Suy tim. tim.  Cng  Non oi, nong giap. giap. ngi ngi U tuy  D ng that s: s: (Kahler). (Kahler). bieu  U.I.V va thai hien da, nghen. nghen. niem niem

CHONG CH Chong ch nh bat NH

KY THUAT
 Benh nhan  ng tiem  Thuoc can quang  Cac giai oan ghi hnh  Ep hay khong ep

 Kieng dung moi chat can

quang trc chup U.I.V t nhat 5 ngay. ngay.

BENH NHAN

 Lam sach ong tieu hoa.  Han che cac chat dch. Nhn dch.
oi tuyet oi t nhat 3 gi trc khi

NG TIEM
V tr phai at yeu cau: cau:  t au. au.  iem kho nhiem trung. trung.  Gi c ng THUOC CAN truyen. truyen.

QUANG

 Loai thuoc  Lieu lng. lng.

CHAT CAN QUANG LY TNG  Tang quang thch hp  An toan  De s dung  Gia thap

W.C.Roentgen (1845-1923)

CHAT CAN QUANG AP THAM CAO (HOCM)1500

L I mOsm/Kg/ H2O BAT LI

Khuech tan gian bao tot -> o can quang cao Bai tiet tot -> can quang nieu qua tnh mach

Tang the tch mau -> t ng cam giac nong, au -> nguy hiem cho tim -> nguy hiem cho than

CHAT CAN QUANG AP THAM THAP(LOCM)500-800 mOsm/Kg/ H2O

L I BAT LI

Hoa lan noi mach cao: -> chup mach mau -> khong nong, au -> bm ong mach tot

Tang the tch mau Bai tiet cham

AP THAM THAU (mOsm/Kg/

H2O)

CH NH
AP THAM CAO  ng tnh mach benh nhan khong co nguy c  CT Scanner  Can quang nieu tnh mach AP THAM THAP ng ong mach (mach mau, vanh, buong tim) ng tnh mach benh nhan co nguy c Chup he tnh mach T cung, buong trng

 

CHAT CAN QUANG KHONG ION HOA

L I BAT LI

 Giam tnh tham thau -> Giam tang the tch mau  Hoa tan nc tot hn -> Giam tac dung ngoai y.

 Chong tao huyet khoi kem -> De tao huyet khoi khi nong vanh (PTCA)

CHAT CAN QUANG ION HOA

L I  Chong ong mau tot: -> giam nguy c tao huyet khoi  Giam s un t c noi m ch -> than dung nap tot  o nht thap: -> d chch -> tang quang tot cac mach mau nho BAT LI
 Chong ch

nh: ->tuy o  Hoa tan nc giam ->tac dung ngoai y

CAC GIAI OAN GHI HNH

- Cao huyet ap ngi tre. tre. - Khoang thi gian. gian. - Cac film chup muon sau tiem. tiem. - Cac yeu cau khac: chup khi BQ khac: cang ay, chup chech trong khi nam tieu nam hoac ng n, chup sau khi tieu, chup NQ oan thap t the nam

EP HAY KHONG  Muc ch ep. EP ep.

 Ap lc ep. ep.  Ep la d tha khi co tac
nghen ng bai nieu. nieu.

 Khong can thiet ep khi ch

can khao sat s tac nghen. nghen. chc nang hoac

 Chong ch nh ep. ep.

L i ch c a

ng tc p

GI I PH U BNH TH

NG

TH N: -V tr D12- L3. -Hnh dng, h d c. -Kch th c. NI U QU N: ng i. -Cc v tr h p sinh l. ng tr c

GI I PH U X QUANG HE NIEU BNH THNG KHI CH P U.I.V.

CAC HNH ANH BAT THNG CUA HE NIEU * Bat thng ve so lng. lng. * Bat thng ve chc nang. nang. * Bat thng ve kch thc va hnh dang. dang. * Bat thng ve v tr. tr. * Bat thng khac. khac.

BAT THNG VE SO LNG

 Than duy nhat: kch thc nhat: thng ln hn bnh thng. thng.  Nhieu than: bat thng BAT THNG VE CHC hiem gap. NANG Mat oi xng bai tiet, co the do: do:  Hoi chng tac nghen cua he bai nieu mot ben. ben.  Hep ong mach than: than: nghiem

BAT THNG VE KCH THC VA HNH DANG

Bat thng nay gap vi t le cao hn bat thng ve so lng. lng.  Than nho (hypoplasia): thng ket (hypoplasia): hp ph ai (hyperplasia) ben oi dien. dien.  S thuy hoa t bao thai (fetal lobulation) can chan oan phan biet vi giam san oan. oan.  Than mong nga. nga.  Be than nieu quan oi: mot oi: hoac ca hai ben than, co the ban phan hay toan phan. phan.

THAN MONG NGA

BE THAN NIEU QUAN OI

U.I.V. BE THAN NQ OI (T)

NANG NIEU QUAN

thng co kem bat thng cua c hoanh. hoanh.  Chan oan nham la u sau phuc mac: mac: than trong khung chau Ch nh chup U.I.V e xac nh, kho khan khi than lac cho mat chc nang. nang.  Bat thng lo o nieu quan: quan: + nam: o vao nieu ao nam: sau,

BAT THNG VE  Co V TR khoang long ngc: the ngc:

THAN LAC CHO

BAT THNG KHAC

 NANG BE THAN HAY TUI
THA AI THAN.

 XOP TUY THAN (MEDULLARY

SPONGE KIDNEY).

NANG NGUON GOC BE THAN

(TUI THA AI THAN) THAN)

XOP TUY THAN

THAN CHNG NC
Nguyen nhan
 a phan tac nghen he nieu la do soi, chu y cac iem hep sinh ly. ly.  t gap hn la: u, ph ai TLT, seo mo, la: tia xa, mau ong, viem co that, nang gia nieu nieu  nam ln tuoi : u tien liet tuyen hoac u bang quang. quang.  Tre em: a phan la bam sinh. em: sinh.  Tac t t va thap, he nieu se gian nhieu va cham mat chc nang. nang.  Tac cap va cao: gian t nhng mat cao: chc nang sm. sm.

Dau hieu

Cac soi thau quang: urat (#4%), cystine (#1%) quang: (#4 (#1 va xanthine. xanthine. Soi thng uon khuon theo hnh dang cua v tr hnh thanh. thanh. Thng khong co lam sang ro, quan trong la tac he bai nieu. nieu. Nhiem trung th thng ket hp va ho tr. tr. Chan thng, benh noi tiet, u co huy xng, Sarcoid, Paget, che o an kieng sai lam lam Dau hieu X quang oi vi soi can quang. quang. oi vi soi khong can quang. quang. Chan oan phan biet vi tat ca cac ong voi khac

SOI THAN VA NIEU Hn 90% la soi QUAN 90% can quang. quang.

SOI NIEU QUAN

SOI THAN KHONG CAN QUANG

U.I.V.

U.P.R.

SOI BANG QUANG.

PH AI TIEN LIET TUYEN MAN TNH

CHOAN CHO VUNG CHAU

HEP KHUC NOI BE THAN NIEU QUAN (T).

HEP LO O NIEU QUAN HAI BEN

NANG NIEU QUAN

SOI TRONG NANG NIEU QUAN

TUI NGACH BQ / SOI + PH AI TLT

BQ DANG CAY NOEL. NOEL

VIEM NHIEM
 VIEM NHIEM CAP TNH  VIEM NHIEM MAN TNH  
KHONG DO LAO LAO HE NIEU

VIEM NHIEM CAP TNH

1.Viem cau than cap Dau hieu X quang khong ien hnh, s phu ne lam tang o day cua nhu mo ong thi ep he bai nieu.. nieu.. 2.Viem be than cap Khong co dau hieu ac hieu tren X quang. quang. 3.Abscess than + a so do Staphylo. en chu mo than thng theo Staphylo. ng mau . + Khi co mot hoac vai o abscess nho th khong co dau hieu X quang. quang. + Neu o abscess ln th ghi nhan hieu ng choan cho khu tru mot vung than, lp m quanh than b xoa. xoa. 4.Abscess quanh than

VIEM NHIEM MAN TNH KHONG DO LAO

. Viem cau than man tnh. tnh. . Viem be than man tnh. tnh. . Viem be than trong thai ky. ky.

VIEM CAU THAN

CAP TNH

MAN TNH

THAN TRONG THAI KY

VIEM BE THAN TIEN TRIEN

KY AU

SAU 2 NAM SAU 4 NAM

VIEM BE THAN MAN TNH

VIEM BE THAN NIEU QUAN TAO NANG

Vim BQ/ BQ d ng kch ng

LAO HE NIEU
 Lay nhiem theo ng mau. Thng mau. th phat sau lao phoi. phoi.  Ton thng khu tru t vung vo en cac thap than.  Tien trien se dan en teo hep va tac nghen he bai nieu.  Tac he bai nieu sau khi than mat chc nang. Ton thng ba au tao nen than mat-tt mat(putty(putty-kidney).  Tac he bai nieu trc khi than mat chc nang.

DAU HIEU X QUANG LAO NIEU  Plain film la s bien oi ve kch thc
va ong voi trong than. than.  Giai oan sm khong co dau hieu tren nieu o. o.  Dau hieu sm nhat la bien dang nhe cua ai than bi s loet cac thap than. than.  Xa hn la s mat thap than bnh thng + hnh thanh cac xoang, lo hong. ket hp hong. vi hep cac ai ln. ln.

LAO THAN

NHIEM KY SINH TRUNG

Co the la cac ong voi thanh nang san vi dang vong hay dang qua le. le. Nang KST co the khep kn, nhng a so m vao mot ai than nen thay c b ngoai khi chup ng nieu vi thuoc can quang. quang. Cac nang ln co the cha daughter cyst. cyst.

NHIEM ECHINOCOCCUS NIEU

NHIEM SCHISTOSOMIA NIEU

Va ap manh,

CHAN trc tiep vao vung THNG

than la

nguyen nhan thng gap. gap. Khao sat U.I.V cang sm cang tot sau chan thng than. than. Dau hieu tren U.I.V Tuy mc o ton thng: thng: +Ton thng mo than nhng khong pha rach vo bao than. +Ton thng pha v vo bao than. khong kem hoac co v he bai nieu . +Ton thng t ong mach than. than. +Ton thng kem rach phuc mac thanh sau..

U.I.V.CHAN THNG THAN (P)

K.U.B. U.I.V

CHAN THNG THAN

CHAN THNG THAN (T).

CHAN THNG T NIEU QUAN

V BNG QUANG NGOI PHC M C

Than a nang

NANG THAN

Benh bam sinh. sinh. Nang ln gan b ngoai than. than. Nang ln vung ron than. than. Nang nho th s thay oi khong ro rang. rang. Than a nang tien trien se pha huy cau truc cua than gay suy than tien trien. trien. Chan oan phan biet: Abces, u biet: than... than...

Nang n oc
Thng cc di. di. Mot t co ong voi trong nang. nang.

1)Neu nang nho th kch thc than bnh thng va khon ng choan cho. 2)a so nang pha b ngoai cua than, co the thay gi hn mo than, b kha net tao b oi, co the o thc nang. 3)ong voi dang ng hay dang vong theo b ngoai na 4)Be than co the b ep hay ay lech. 5)ai ln gian dai ket hp vi b ep hay ay lech. 6)Cac ai ln va ai nho b ay lech tu thanh am. 7)ai ln b ep th thng gap khi nang trung tam. 8)ai ln b cat cut th hiem gap. 9)Dang bien dang n thuan cua ai ln. 10)Co the khong thay bien dang cac ai neu nang than.

NANG THAN

Nang th n p b th n

HNH MINH HOA

ROI LOAN CHUYEN HOA

CNG TUYEN CAN GIAP

U NIEU

U THAN Tren U.I.V kho phan biet gia u lanh va u ac hay

ngi ln: ln:

nang than. than. Khoang 15% u ac co ong voi khong co hnh 15% dang nhat nh. nh.

U te bao chu mo than : neu ln se gay hieu ng choan cho. cho. Carcinoma te bao than thng gap, dang t te bao chuyen tiep cua he thong gop t gap hn. hn. Tan sinh ai, be than co dang nhu, hiem khi ong voi, do v tr nen thng cho trieu chng sm, phat hieu luc u nho. nho.

Tre em: em:

2)To chc choan ch trong mo than, b khong ro, thng tang am o hn nhu mo than. 3)ong voi trung tam hay lech tam, thng khong co hnh dang nhat nh. 4)Be than co the b ep, ay lech hay xam lan. 5)ai ln b bien dang dai ra, thng ket hp vi cat cut ai than nho. 6) Cac ai than b ay lech nhng thng van tach ri. 7)Hnh anh ep cac ai than, ac biet khi u trung tam. 8)S cat cut ai than rat thng gap . 9)S bien dang phc tap va ky quai cua cac ai than. 10)Co the khong thay bien dang ai than neu u gan b ngoai than.

ANGIOMYOLIPOMA

CARCINOMA TE BAO THAN

CARCINOMA HE BAI NIEU

CARCINOMA BE THAN

BU WILMS

CARCINOMA NIEU QUAN

CARCINOMA BANG QUANG

BENH LY MACH MAU THAN

+ HEP ONG MACH THAN + TUI PHNH ONG MACH THAN + NHOI MAU THAN + HUYET KHOI TNH MACH THAN

HEP ONG MACH THAN

TAC ONG MACH THAN

U.I.V U.P.R U.I.V SAU 2 THANG

Nh i mu c c trn th n (P)

HNH MINH HOA

CAC TRNG HP HIEM GAP

BANG QUANG OI

HI TRONG BANG QUANG

Hi trong bang quang.