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신우주위 낭종이었다고 하며... - 동대문구 답십리, 전농동, 우리안애 우리안愛 내과


상기 환자 6개월 지나 감기 진료 위해 내원...

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상기 소견으로 **대학교 비뇨기과에서 검사, 아마도 CT...

신장 주변 낭종이 5 cm 크기였다고 하며, 1년뒤 추적 예정

; 7 cm 이상이면 흡인할 계획?

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그러나, 과거 내원당시 복통을 설명하기엔 위치가 멀다.

하부요로의 폐쇄를 일으킬 요관의 병변을 배제했을 것으로 생각된다.


Parapelvic cysts and hydronephrosis can be difficult to distinguish on ultrasound, 초음파로 구별하기 어려우나... but there are some differences that can help differentiate between the two:

  • Appearance

  • Parapelvic cysts are more spherical, while hydronephrosis has an irregular or cauliflower-like contour. 낭종은 더 둥글고...

  • Communication

  • Parapelvic cysts are non-communicating renal sinus cystic masses, while hydronephrosis appears as branching, interconnected areas. 낭종은 신우와 연결되지 않으며.. 판단은? --> CT 조영제가 신우를 통해 나오지만 낭종 안에 들어가지 않을 것이다.

  • Connection to the ureter

  • Parapelvic cysts are not connected to the ureter distally. 낭종은 요로와도 연결되지 않으며...

  • Axis projection

  • If the axis projects toward the renal papilla, it favors a diagnosis of hydronephrosis.

A CT scan with contrast can help differentiate between the two conditions. 조영제를 사용한 CT가 구별하는데 도움이 된다.

Parapelvic cysts are uncommon conditions that are often found during autopsy. They are located on or near the kidney in close proximity to the pelvis and major calyces. They are usually asymptomatic, but if they obstruct the normal urinary tract, they can cause hydronephrosis.

Hydronephrosis is usually caused by a blockage in the urinary tract or something disrupting the normal workings of the urinary tract. Treatment may involve draining excess urine from the kidney, removing the blockage, or taking antibiotics.

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Here are some criteria for treating parapelvic cysts:

  • Cyst aspiration

  • A safe and effective procedure that can be performed with or without a sclerosing agent. The cyst should be punctured as gently as possible to reduce bleeding. A cystogram should be performed after aspiration to replace the cyst fluid with dilute contrast.

  • Sclerotherapy

  • A treatment option for simple renal cysts that can cause hydronephrosis. Ethanol is injected into the cyst after the contrast media is aspirated. The patient should be rolled into different positions to ensure the ethanol comes into contact with all surfaces of the cyst.

  • Laparoscopic decortication

  • A safe and effective procedure that provides direct access to the cyst. The cyst is cleared of tissue and fat, and fluid is aspirated. The cystic wall is excised, and the base is packed with perirenal fat to prevent recurrence.

  • Flexible ureteroscopy

  • A procedure that can be used to locate the cyst and perform marsupialization. A flexible ureterorenoscope is guided to the cyst wall using ultrasound. The laser is then triggered to make an incision and drain the cyst.

Parapelvic cysts are rare and can be difficult to diagnose. A combination of imaging modalities, such as ultrasound, CT, and MAG3 renogram, can help with diagnosis and monitoring treatment.

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The parapelvic cyst is related to urinary tract obstruction. The patient with this condition usually has a medical history of urinary tract obstruction, concretion, or infectious disease. Some researchers consider that this is due to the local expansion of pelvic lymphatic vessels caused by chronic inflammation. The greater parapelvic cysts could lead to compression on the renal pelvis, vessels and lymphatic vessels. More seriously, this could lead to severe uronephrosis, renovascular hypertension or kidney failure. The most common clinical features of this disease include pain (98%), urinary tract infection (9.5%) and haematuria [4.8%]. 너무 커지면 주변을 눌러서... 수진승, 신혈관성 고혈압, 신부전등을 야기할 수 있다. 가장 흔한 임상적 증상은 통증, 요로감염, 혈뇨가 될 수 있다.

The aim of parapelvic cyst treatment is to have complete drainage of cyst fluid and prevent its further compression on the kidney and collective system.



동대문구 답십리 우리안애, 우리안愛 내과, 건강검진 클리닉 내과 전문의 전병연



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