年月小儿科XRay课件完整版.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.Pelvic MRI was arranged for herAbdominal echo:07/15Pelvic MRI07/15Pelvic MRIsolitary hypertrphic Lt kidney with Rt kidney agenesis07/07 CXRPulmonary hemorrhageAntinuclear Factor:160+,Anti-ds DNA:negativeShe was found pale lookin

5、g and occasional cough with blood-tinged sputum(hemoptysis)since 6 months ago.07/09 Abd.07/09 Chest CTPulmonary homorrhageCC:Dry cough noted since 12 y/o and became productive since 13 y/o,acute exacerbation twice in recent 1/2 years廖x博 6 Y/O MalePelvic MRI was arranged for her07/09 Abd.Pelvic MRI w

6、as arranged for herPerinuclear ANCA:PositiveAbdominal echo:Perinuclear ANCA:PositiveC3:129 MG/DL;C4:30 MG/DL;(WNL)07/07 CXRPulmonary hemorrhage 07/09 Chest CTPulmonary homorrhage07/09 Chest CTConsistent with HSP.CC:coca cola-colored urine was noted todayCytoplasmic ANCA:negativeCC:Intermittent abdom

7、inal pain over RLQ and infraumbilical area at interval of 1 month since 6 months ago07/20 Chest CTBronchiectasis picture廖x博 6 Y/O MaleCC:coca cola-colored urine was noted todayCT Pus accumulation07/15Pelvic MRI邱x華 11 Y/O female07/20 Chest CTBronchiectasis picturePH:Suspect Appendicitis under antibio

8、tics treatment 94/03/1094/03/1507/15Pelvic MRI07/15Pelvic MRIAbdominal echo:07/07 CXRPulmonary hemorrhageCC:coca cola-colored urine was noted todayShe was found pale looking and occasional cough with blood-tinged sputum(hemoptysis)since 6 months ago.CC:coca cola-colored urine was noted today陳x任 15 Y

9、/O male07/09 Chest CT07/15Pelvic MRI07/09 Chest CTCase 2 Renal biopsy was arranged:RPGN with 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 producti

10、ve since 13 y/o,acute exacerbation twice in recent 1/2 years CXR and Chest CT was arrnaged.07/06 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 sin

11、ce 6 months ago Abdominal echo:1.a multilocular cystic mass(12*11*10cm)in pelvis 2.solitary hypertrphic Lt kidney with Rt kidney agenesis Pelvic MRI was arranged for her07/15Pelvic MRI07/15Pelvic MRI07/15Pelvic MRI07/09 Abd.07/20 Chest CTIGA:198 MG/DL;(WNL)07/15Pelvic MRICC:coca cola-colored urine w

12、as noted today07/20 Chest CT07/09 Abd.CC:coca cola-colored urine was noted todaya multilocular cystic mass(12*11*10cm)in pelvis07/15Pelvic MRIsolitary hypertrphic Lt kidney with Rt kidney agenesis07/15Pelvic MRI07/09 Abd.CC:coca cola-colored urine was noted todayAbdominal echo:CT Pus accumulationPel

13、vic MRI was arranged for hersolitary hypertrphic Lt kidney with Rt kidney agenesis07/20 Chest CTBronchiectasis pictureAntinuclear Factor:160+,Anti-ds DNA:negativeRenal biopsy was arranged:RPGN with crescent formation,IgA deposition.Laparotomy was arranged on 94/0707/15Pelvic MRI07/15Pelvic MRICC:coc

14、a cola-colored urine was noted todayCC:abdominal pain since 2 days ago(maily RLQ and lower abdomen)07/20 Chest CTBronchiectasis picturePH:Suspect Appendicitis under antibiotics treatment 94/03/1094/03/15solitary hypertrphic Lt kidney with Rt kidney agenesis07/15Pelvic MRIPelvic MRI was arranged for

15、herConsistent with HSP.Antinuclear Factor:160+,Anti-ds DNA:negative07/15Pelvic MRI07/09 Abd.CXR and Chest CT was arrnaged.Perinuclear ANCA:Positive07/15Pelvic MRIsolitary hypertrphic Lt kidney with Rt kidney agenesisTherefore,plain abdomen and abdominal CT was arranged07/20 Chest CT07/15Pelvic MRIAn

16、tinuclear Factor:160+,Anti-ds DNA:negativeCC:coca cola-colored urine was noted todayAntinuclear Factor:160+,Anti-ds DNA:negative廖x博 6 Y/O MaleCC:coca cola-colored urine was noted todayAntinuclear Factor:160+,Anti-ds DNA:negativeCC:coca cola-colored urine was noted todayPelvic MRI was arranged for he

17、rCC:abdominal pain since 2 days ago(maily RLQ and lower abdomen)Therefore,plain abdomen and abdominal CT was arrangeda multilocular cystic mass(12*11*10cm)in pelvisPelvic MRI was arranged for hersolitary hypertrphic Lt kidney with Rt kidney agenesisRenal biopsy was arranged:RPGN with crescent format

18、ion,IgA deposition.CC:abdominal pain since 2 days ago(maily RLQ and lower abdomen)Abdominal echo:PH:Suspect Appendicitis under antibiotics treatment 94/03/1094/03/1507/15Pelvic MRICC:coca cola-colored urine was noted today07/09 Chest CTShe was found pale looking and occasional cough with blood-tinge

19、d sputum(hemoptysis)since 6 months ago.Abdominal echo:C3:129 MG/DL;C4:30 MG/DL;(WNL)Therefore,plain abdomen and abdominal CT was arrangedSurvey at other hospital showed normocytic anemia.CC:abdominal pain since 2 days ago(maily RLQ and lower abdomen)07/09 Chest CTPulmonary homorrhageAbdominal echo:C

20、T Pus accumulationIGA:198 MG/DL;(WNL)CT Pus accumulation陳x任 15 Y/O malePH:cystic fibrosis diagnosed on 2004-12Pelvic MRI was arranged for hera multilocular cystic mass(12*11*10cm)in pelvis07/15Pelvic MRI07/20 Chest CTBronchiectasis pictureConsistent with HSP.PH:Suspect Appendicitis under antibiotics

21、 treatment 94/03/1094/03/1507/20 Chest CTBronchiectasis picture07/09 Abd.07/20 Chest CT07/15Pelvic MRI07/20 Chest CTBronchiectasis picture07/15Pelvic MRIAbdominal echo:solitary hypertrphic Lt kidney with Rt kidney agenesis07/09 Abd.Abdominal echo:CT Pus accumulationIGA:198 MG/DL;(WNL)07/20 Chest CTR

22、enal biopsy was arranged:RPGN with crescent formation,IgA deposition.07/09 Abd.PH:Suspect Appendicitis under antibiotics treatment 94/03/1094/03/1507/15Pelvic MRI07/07 CXRPulmonary hemorrhageShe was found pale looking and occasional cough with blood-tinged sputum(hemoptysis)since 6 months ago.PH:cys

23、tic fibrosis diagnosed on 2004-12Therefore,plain abdomen and abdominal CT was arranged07/15Pelvic MRIAbdominal echo:CXR and Chest CT was arrnaged.94年7月小兒科X-Ray Conference(07/25)07/15Pelvic MRICXR and Chest CT was arrnaged.Pelvic MRI was arranged for her07/20 Chest CTsolitary hypertrphic Lt kidney wi

24、th Rt kidney agenesisConsistent with HSP.王x云 9 Y/O femaleCT Pus accumulationPelvic MRI was arranged for her07/15Pelvic MRICC:coca cola-colored urine was noted todayCT Pus accumulationAntinuclear Factor:160+,Anti-ds DNA:negativePerinuclear ANCA:Positive07/20 Chest CTBronchiectasis picturePerinuclear

25、ANCA:Positive07/20 Chest CTBronchiectasis pictureCC:Dry cough noted since 12 y/o and became productive since 13 y/o,acute exacerbation twice in recent 1/2 yearsCytoplasmic ANCA:negative07/15Pelvic MRIShe was found pale looking and occasional cough with blood-tinged sputum(hemoptysis)since 6 months a

26、go.07/07 CXRPulmonary hemorrhage07/07 CXRPulmonary hemorrhage07/15Pelvic MRIPerinuclear ANCA:PositiveCT Pus accumulationAbdominal echo:CT Pus accumulationCC:Dry cough noted since 12 y/o and became productive since 13 y/o,acute exacerbation twice in recent 1/2 years94年7月小兒科X-Ray Conference(07/25)07/0

27、7 CXRPulmonary hemorrhageCytoplasmic ANCA:negativea multilocular cystic mass(12*11*10cm)in pelvis07/09 Abd.07/15Pelvic MRICC:Intermittent abdominal pain over RLQ and infraumbilical area at interval of 1 month since 6 months agoIGA:198 MG/DL;(WNL)Pelvic MRI was arranged for herAbdominal echo:CXR and

28、Chest CT was arrnaged.Pulmonary renal syndrome was suspectedSurvey at other hospital showed normocytic anemia.IGA:198 MG/DL;(WNL)Cytoplasmic ANCA:negativePelvic MRI was arranged for herPH:Suspect Appendicitis under antibiotics treatment 94/03/1094/03/1507/20 Chest CTCT Pus accumulationAntinuclear Factor:160+,Anti-ds DNA:negativeCC:abdominal pain since 2 days ago(maily RLQ and lower abdomen)Case 4 Laparotomy was arranged on 94/07 Final diagnosis:Duplication of uterus and Vagina,right side obstruction and hydrometrocolpous