189.Right Renal Pseudolesion（右肾假性病变）

HISTORY: A 50-year-old male with a history of a right renal cell carcinoma status post-partial right nephrectomy.

病史：男性50岁，右肾细胞癌行右肾后极切除术。

FINDINGS: Axial CT of the abdomen demonstrates a 4-cm “fatty” lesion along the lateral periphery of the right kidney (Fig. 13.21.1).

影像表现：腹部轴位CT可见右肾外侧缘约4cm的脂肪病变。

DIAGNOSIS: Right renal pseudolesion caused by fat packing from previous partial nephrectomy

诊断：右肾部分肾切除术后脂肪填充形成的假性病灶。

DISCUSSION: A case such as this reminds the radiologists of the importance of clinical history, particularly prior surgical intervention. For patients who are status post-partial nephrectomy, the postoperative kidney typically has a wedge-shaped parenchymal defect, usually abuts and adheres to the dorsal abdominal wall, and shows adjacent fibrotic or reactive changes in the perinephric space. In some cases (as this one showed), the surgeon chooses to pack the surgical defect with fat to lower the possibility of postoperative bleeding. Over time, the adipose-rich packing material can take on a similar appearance to an AML and misdiagnosis can easily occur without a thorough investigation for any prior renal surgeries.

讨论：这则病例提示影像科医生诊断中结合临床病史的重要性，尤其是手术史。对于部分肾切除术的患者，肾脏上有典型的楔形缺损，通常紧邻背侧腹壁，导致肾周间隙纤维化或者反应性改变。在某些病例中，医生会选择用脂肪材料来填充切除组织，降低出血风险。随时间增长，富含脂肪成分的材料可呈类似血管平滑肌脂肪瘤的表现。若没有对手术史详细了解，很容易误诊。

以上主题选自: 腹部影像病例汇

Notes：

1. nephrectomy [nɪ'frektəmɪ] n. 肾切除术

2. pseudolesion ['su:doʊ] 假病灶

3. parenchymal [pə'rəŋkəməl] 实质的

4. dorsal [ˈdɔ:rsl] adj. 背的

5. perinephric 肾周的

深圳市人民医院放射科副主任医师杨敏洁

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