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患者男,59岁。1周前无明显诱因出现无痛性血尿,为全程肉眼血尿,伴血凝块,无发热畏寒,不伴腰腹痛,院外未行治疗,血尿症状自行缓解。患者长期嗜烟,1~2包/天。体检:全身情况可,膀胱区深压痛,左侧肾区叩击痛(±)。B超提示膀胱肿瘤,左肾囊肿。CT表现:左肾上极可见一圆形占位病变,密度不均,其内见片状坏死区,增强后病灶动脉期强化明显,坏死区无强化,静脉期强化程度稍减弱,病灶与胰腺尾部分界不清(图1~3)。膀胱左后壁见一不规则菜花状结节,强化较明显(图4、5)。
Male patient, 59 years old. 1 week ago no obvious incentive to appear painless hematuria, the whole process of gross hematuria, with blood clots, no fever chills, without abdominal pain, no treatment outside the hospital, hematuria symptoms relieve themselves. Long-term addiction patients, 1 to 2 packs / day. Physical examination: general condition may be, deep tenderness in the bladder area, percussion pain (±) in the left kidney area. B-Tip bladder cancer, left renal cysts. CT showed: the left kidney can be seen a circular space-occupying lesions, uneven density, see the necrotic area within the lesion enhanced enhanced obvious arterial phase, no necrosis of the area, a slight weakening of the venous phase, the lesion and the pancreas Trailing unclear boundary (Figure 1 ~ 3). See irregular bladder cauliflower nodules on the left posterior wall of the bladder, strengthening the more obvious (Figure 4,5).