Казуистика в медицине

Автор: Гаевская А. С.. Опубликовано в Блог главной

Казуистика в медицине - отдельное наблюдение (повреждения или заболевания), представляющие научный и практический интерес ввиду его редкости и необычности.

Молодая женщина 25 лет, медицинская сестра, беременность 24 недели. 

В анамнезе хронический пиелонефрит. На момент смотра жалоб нет, ОАМ - норма. На исследование была направлена в плановом порядке.

Неожиданно ни для кого в левой почке обнаружено объемное образование очень больших размеров, гетерогенной эхоструктуры с акустической тенью. Было высказано предположение о злокачественной забрюшинной тератоме с прорастанием в почку.

 

На снимках левая почка и опухоль.

 

На снимках почечная артерия и единичные локусы кровотока по периферии опухоли.

 

 

На снимке левое забрюшинное пространство с опухолью и единичными забрюшинными лу, расцененными как мтс опухоли.

 

Пациентке проведено МРТ, осмотрена врачами онкологами в Москве. Биопсию опухоли не провели. Беременность решено было пролонгировать, опухоль наблюдать.

 

Беременность пациентка доносила, оперативное родоразрешение путем кесарева сечения. После родов на прием к онкологам не поехала.

Поступила в экстренном порядке через 6 мес после родоразрешения с сильными болями в спине, температура тела - норма, анализы - норма.

После родов визуализация опухоли стала более отчетливой.

На снимках почка с опухолью.

 

 

 

 

 

 

 

 

 

В левом забрюшинном пространстве гетерогенные опухолевые массы со скудным кровотоком.

 

 

От операции отказалась.

Через 3 мес вновь поступила на скорую с температурой 40 град. Госпитализирована в урологическое отделение и по жизненным показаниям экстренно прооперирована. Увиденное на операции очень удивило урологов. Опухоль оказалась огромным скоплением гноя в забрюшинном пространстве. Почка удалена, гнойник дренирован, получено 2л гноя. Результаты гистологии - гнойный пиелонефрит.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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