小儿科XRay教学讲解课件.ppt

1、9494年年7 7月小兒科月小兒科X-Ray Conference(07/25)X-Ray Conference(07/25)報告者報告者:兒科兒科 丁瑋信丁瑋信/放射科放射科 施君鏻醫師施君鏻醫師 Case 1 廖x博 6 Y/O Male CC:abdominal pain since 2 days ago(maily RLQ and lower abdomen)PH:Suspect Appendicitis under antibiotics treatment 94/03/1094/03/15 PE revealed tenderness over RLQ with muscle gu

2、arding and rebounding pain.Therefore,plain abdomen and abdominal CT was arranged07/07 Plain abdomen07/09 Abd.CT07/09 Abd.CT Pus accumulationCase 2王x云 9 Y/O female CC:coca cola-colored urine was noted today PH:She was found pale looking and occasional cough with blood-tinged sputum(hemoptysis)since 6

3、 months ago.Survey at other hospital showed normocytic anemia.Urinalysis:RBC:Numerous/HPF WBC:65/HPF Case 2 Pulmonary renal syndrome was suspected D/D:microscopic polyangiitis,HSP Autoimmune survey:C3:129 MG/DL;C4:30 MG/DL;(WNL)Antinuclear Factor:160+,Anti-ds DNA:negativeIGA:198 MG/DL;(WNL)Perinucle

4、ar ANCA:PositiveCytoplasmic ANCA:negative CXR and Chest CT was arrnaged.07/15Pelvic MRIRenal biopsy was arranged:RPGN with crescent formation,IgA deposition.07/20 Chest CTBronchiectasis picture報告者:兒科 丁瑋信/放射科 施君鏻醫師Survey at other hospital showed normocytic anemia.Laparotomy was arranged on 94/07solit

5、ary hypertrphic Lt kidney with Rt kidney agenesisCC:coca cola-colored urine was noted today07/09 Abd.07/07 CXRPulmonary hemorrhage07/20 Chest CTBronchiectasis picture07/15Pelvic MRIa multilocular cystic mass(12*11*10cm)in pelvisPerinuclear ANCA:PositiveLaparotomy was arranged on 94/07Perinuclear ANC

6、A:Positivesolitary hypertrphic Lt kidney with Rt kidney agenesisPH:cystic fibrosis diagnosed on 2004-1207/15Pelvic MRIa multilocular cystic mass(12*11*10cm)in pelvis07/07 CXRPulmonary hemorrhage 07/09 Chest CTPulmonary homorrhage07/09 Chest CT07/09 Chest CTCase 2 Renal biopsy was arranged:RPGN with

7、crescent formation,IgA deposition.Consistent with HSP.Final diagnosis:Henoch-Schonlein purpuraCase 3陳x任 15 Y/O male PH:cystic fibrosis diagnosed on 2004-12 CC:Dry cough noted since 12 y/o and became productive since 13 y/o,acute exacerbation twice in recent 1/2 years CXR and Chest CT was arrnaged.07

8、/06 CXR07/20 Chest CTBronchiectasis picture07/20 Chest CTBronchiectasis picture07/20 Chest CTCase 4邱x華 11 Y/O female CC:Intermittent abdominal pain over RLQ and infraumbilical area at interval of 1 month since 6 months ago Abdominal echo:1.a multilocular cystic mass(12*11*10cm)in pelvis 2.solitary h

9、ypertrphic Lt kidney with Rt kidney agenesis Pelvic MRI was arranged for her報告者:兒科 丁瑋信/放射科 施君鏻醫師a multilocular cystic mass(12*11*10cm)in pelvisPerinuclear ANCA:PositiveIGA:198 MG/DL;(WNL)CC:Dry cough noted since 12 y/o and became productive since 13 y/o,acute exacerbation twice in recent 1/2 years07

10、/15Pelvic MRI07/15Pelvic MRI邱x華 11 Y/O female07/15Pelvic MRIa multilocular cystic mass(12*11*10cm)in pelvis報告者:兒科 丁瑋信/放射科 施君鏻醫師C3:129 MG/DL;C4:30 MG/DL;(WNL)07/15Pelvic MRI07/20 Chest CTBronchiectasis picturesolitary hypertrphic Lt kidney with Rt kidney agenesis07/09 Chest CTAbdominal echo:Final dia

11、gnosis:Henoch-Schonlein purpuraCC:Dry cough noted since 12 y/o and became productive since 13 y/o,acute exacerbation twice in recent 1/2 years07/15Pelvic MRIFinal diagnosis:Henoch-Schonlein purpura07/15Pelvic MRI07/15Pelvic MRI07/15Pelvic MRI07/15Pelvic MRI07/15Pelvic MRI07/20 Chest CTBronchiectasis

12、 picture07/15Pelvic MRITherefore,plain abdomen and abdominal CT was arranged廖x博 6 Y/O MaleD/D:microscopic polyangiitis,HSP王x云 9 Y/O femalePH:cystic fibrosis diagnosed on 2004-12Pulmonary renal syndrome was suspectedPulmonary renal syndrome was suspectedCT Pus accumulationAutoimmune survey:Abdominal

13、echo:Final diagnosis:Henoch-Schonlein purpura廖x博 6 Y/O MalePerinuclear ANCA:Positive廖x博 6 Y/O Male07/15Pelvic MRI邱x華 11 Y/O femaleAutoimmune survey:solitary hypertrphic Lt kidney with Rt kidney agenesisa multilocular cystic mass(12*11*10cm)in pelvisLaparotomy was arranged on 94/07D/D:microscopic pol

14、yangiitis,HSP邱x華 11 Y/O femaleAutoimmune survey:07/15Pelvic MRILaparotomy was arranged on 94/07Cytoplasmic ANCA:negative07/15Pelvic MRI07/15Pelvic MRI07/15Pelvic MRIPulmonary renal syndrome was suspectedShe was found pale looking and occasional cough with blood-tinged sputum(hemoptysis)since 6 month

15、s ago.Pulmonary renal syndrome was suspectedCXR and Chest CT was arrnaged.CC:abdominal pain since 2 days ago(maily RLQ and lower abdomen)CXR and Chest CT was arrnaged.07/15Pelvic MRI07/07 CXRPulmonary hemorrhagea multilocular cystic mass(12*11*10cm)in pelvis07/09 Chest CTa multilocular cystic mass(1

16、2*11*10cm)in pelvissolitary hypertrphic Lt kidney with Rt kidney agenesis07/15Pelvic MRIPH:Suspect Appendicitis under antibiotics treatment 94/03/1094/03/15Perinuclear ANCA:PositiveFinal diagnosis:Henoch-Schonlein purpura07/09 Abd.Final diagnosis:Henoch-Schonlein purpuraAntinuclear Factor:160+,Anti-

17、ds DNA:negative07/20 Chest CTBronchiectasis picture廖x博 6 Y/O MaleCC:Intermittent abdominal pain over RLQ and infraumbilical area at interval of 1 month since 6 months agoPerinuclear ANCA:Positive07/15Pelvic MRI07/15Pelvic MRIa multilocular cystic mass(12*11*10cm)in pelvisPH:cystic fibrosis diagnosed

18、 on 2004-1207/20 Chest CTPulmonary renal syndrome was suspectedCC:Dry cough noted since 12 y/o and became productive since 13 y/o,acute exacerbation twice in recent 1/2 yearsC3:129 MG/DL;C4:30 MG/DL;(WNL)Laparotomy was arranged on 94/07Final diagnosis:Henoch-Schonlein purpuraFinal diagnosis:Henoch-S

19、chonlein purpuraC3:129 MG/DL;C4:30 MG/DL;(WNL)Pulmonary renal syndrome was suspectedD/D:microscopic polyangiitis,HSPRenal biopsy was arranged:RPGN with crescent formation,IgA deposition.07/09 Abd.07/15Pelvic MRI07/15Pelvic MRIPerinuclear ANCA:Positive07/09 Chest CTPulmonary homorrhagea multilocular

20、cystic mass(12*11*10cm)in pelvis07/15Pelvic MRICC:Dry cough noted since 12 y/o and became productive since 13 y/o,acute exacerbation twice in recent 1/2 years07/15Pelvic MRILaparotomy was arranged on 94/07CXR and Chest CT was arrnaged.a multilocular cystic mass(12*11*10cm)in pelvisCC:coca cola-colored urine was noted todayPulmonary renal syndrome was suspectedRenal biopsy was arranged:RPGN with crescent formation,IgA deposition.07/15Pelvic MRICase 4 Laparotomy was arranged on 94/07 Final diagnosis:Duplication of uterus and Vagina,right side obstruction and hydrometrocolpous