泌尿 腹膜后肿瘤分类及特性

绝大多数恶性，恶性纤维组织细胞瘤>脂肪肉瘤>平滑肌肉瘤

畸胎瘤：脂肪，钙化
脂肪瘤：均值脂肪
脂肪肉瘤：不均质肿块+脂肪
平滑肌肉瘤：大范围坏死+肾静脉、下腔静脉受累
神经母细胞瘤：钙化
副节瘤：主动脉旁，囊变，临床儿茶酚胺过多
神经鞘瘤：明显囊变
神经纤维瘤：均匀低密度

骨骼 Scheuermann's disease 少年性椎体骨软骨病

Defined as anterior wedging of greater than 5 degrees involving three or more adjacent thoracic vertebral bodies. Other features of the disease include end-plate irregularity and Schmorl's nodes. Scheuermann's disease is typically painful, unlike idiopathic scoliosis.

The etiology of Scheuermann's disease is unknown. Possible causes include underdevelopment of the anterior spine, congenital end-plate weakness, or repetitive microtrauma.

泌尿 肾积水时IVP的一些征象

肾盂负影：梗阻性积水，肾实质显影，肾盂延迟显影时显示为负影。

梗阻性肾影：急性梗阻时，肾实质密度增加，肾盂肾盏延迟显影。（高位梗阻优甚）

新月形肾盏：肾盏明显扩张，肾脏集合管受压、重排，肾脏外新月形影，点状影。

泌尿 Fraley syndrome

a. Intravenous urography (nephrotomogram) showing slight fullness of the right upper pole calyces, with an associated lucency crossing the left upper pole infundibulum. b. Abdominal aortogram shows an artery (arrow) in the position corresponding to the lucency seen on intravenous urography, confirming the diagnosis of Fraley'syndrome.

肾动脉、静脉引起肾盂肾盏系统外在压迫，导致上组肾盏漏斗部压迫梗阻。

相关：肾动脉分为前后两支，前支分布于前下方，位于肾静脉及肾盂之间，后支分布于后上方，位于肾盂后。

a rare condition in which crossing vessels causes partial obstruction of the upper pole infundibulum, and back pain ensues. Crossing vessels are generally asymptomatic. The diagnosis can be suggested by findings on excretory urography (Fig.1) where there is isolated dilatation of the upper pole infundibulum.

中枢 不典型畸胎样/横纹肌样瘤

不典型畸胎样/横纹肌样瘤（Atypical Teratoid / Rhabdoid Tumor, AT/RT ） WHO Ⅳ级
原发性不典型畸胎样/横纹肌样瘤（Atypical Teratoid / Rhabdoid Tumor, AT/RT ）属于胚胎性肿瘤的一个亚类，是非常罕见的中枢神经系统的高度恶性的肿瘤，常发生于儿童。具有高度侵袭性及在CNS播散的潜力。其成分复杂，含有多个胚层，包括横纹肌瘤样细胞、原始神经外胚层肿瘤（PNET）细胞、间充质纺锤形样肿瘤细胞和/或上皮型肿瘤细胞，因此命名为不典型畸胎样/横纹肌样瘤。

由于其组织成分与PNET有较多重叠，过去多误诊为PNET/髓母细胞瘤或其它肿瘤（脑膜瘤等），近来由于免疫组织化学技术及分子基因技术的发展，通过特定的免疫组化标记物能够将AT/RT与其它肿瘤鉴别开来，包括EMA、vimentin、actin、hSNF5/INI1染色及基因分析。 94%在脑内，幕下多见，亦可位于幕上或椎管内。肿瘤体积常较大，易坏死、囊变、出血； 肿瘤供血丰富，常可见小流空的肿瘤血管信号影； 肿瘤强化明显，多呈环形强化，近正常脑组织面强化较内侧面更明显，也可呈实质性明显强化。 常发生脑脊液播散性转移至脑室、脊髓（24%）。 预后极差，1年及5年存活率分别为71%及28%。

鉴别诊断： PNET 髓母细胞瘤 胶质母细胞瘤 脑膜瘤等

呼吸 Congenital Lobar Emphysema

Marked hyperexpansion of left upper lobe with collapse of left lower lobe and mediastinal shift.

General

Progressive overdistension of lobe at birth
Male predominance 3:1
Associated with CHD in 15% (PDA,VSD)
Symptoms: respiratory distress (90%) and cyanosis <>

Mortality: 10%

Treatment: surgical resection

Etiology

Immaturity of bronchial cartilage

Endobronchial obstruction (fold, web, mucus)

Bronchial compression from vascular structure e.g. PDA, aberrant left pulmonary artery

Location
LUL 43%，RML 35%，RUL 20%，Two lobes involved 5%

X-ray Appearance

Mass-like opacity following birth

Lucency develops over next two weeks

Air-trapping occurs in affected lobe

Compression atelectasis of adjacent lobes

Shift of mediastinum away from lesion

http://www.learningradiology.com/lectures/chestlectures/conglobaremphysemappt_files/frame.htm

呼吸 仰卧位时气胸的判定 deep sulcus sign

Supine chest radiograph of a neonate illustrates the deep sulcus sign with abnormal deepening and lucency of the left lateral costophrenic angle (*). Findings on right lateral decubitus chest radiograph (not shown) confirmed the presence of a pneumothorax on the left side.

Supine chest radiograph demonstrating signs of a right supine pneumothorax despite the presence of a chest drain. There is abnormal lucency over the lower right chestand upper abdomen. Subpulmonic air (white asterisk) out-lines the inferior surface of the lung with sharp delineationof the right hemidiaphragm. The right side of the medias-tinum is unusually well defined (black arrows) because of theadjacent air rather than normal aerated lung. The deepsulcus sign is also seen (white arrow).

Detection of Pneumothorax in the Supine Subject

In the supine position, air within the pleural space rises to the highest point in the hemithorax, which is in the area of the hemidiaphragm. This makes it less likely that one will see the classic visceral pleural line -- indeed, supine films are relatively insensitive in detecting pneumothoraces (50 - 70 %). One may increase the pickup rate with the use of expiratory radiographs or with CT of the chest. However, it is also useful to learn the following secondary signs of pneumothorax on the supine radiograph:

*deep sulcus sign

*relative lucency in the hypochondrial（季肋部） region or the entire hemithorax;

*depression of an ipsilateral hemidiaphragm;

*double-diaphragm appearance due to air outlining of the anterior costophrenic angle and aerated lung outlining the diaphragmatic dome;

*improved sharpness of the cardiomediastinal border due to anteromedial collection of air, which may appear as a lucency;

*increased sharpness of the pericardial fat pads;

*visible inferior edge of a collapsed lower lobe or of the undersurface of the heart due to air in the pleural space;

*band of air in the minor fissure bounded by two visceral pleural lines;

*visible lateral edge of the right middle lobe due to medial retraction in the presence of anterior pneumothorax.

http://radiology.rsnajnls.org/cgi/content/full/228/2/415