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DR.BAHRİ YILDIZ
BÖBREK ÜSTÜ BEZİNİN
ULTRASONOGRAFİSİ
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ADRENAL GLAND ULTRASONOGRAFİ
(ADRENAL SONOGRAPHY)DR.BAHRİ YILDIZ
AİLE HEKİMLİĞİ A.B.D ARŞ.GÖRV
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Sağ suprarenal bölgede ,iyi-sınırlı solid görünümlü kitle görünen karaciğer ve İVC normal
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. İyi-sınırlı ,heterojen kitle tekrar görünmekte İVC baskı yapıyor ama invazyon yok
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İyi-sınırlı ,hipoekoik yuvarlak kitle (sağ adrenal bölgede ) görünen kc ve hepatik ven normal
İVC ye baskı yaptığını Görün
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Kitlenin extrahepatik görünümü ortada inferior vena kava anterior da n baskı altında
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Kitlede belirgin bir kanlanma yoktur.
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İyi sınırlı yuvarlak ,hafif lobule hipoekoik kitle karaciğerden belirgin ayrım göstermektedir. Ve kitlede kalsifikasyon alanları ile böbreği aşağı ve mediale itmiştir.
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Sağ böbrekte yer değişikliğine neden olan ve belirgin olarak böbrekten ayrılan Ok işaretli kalsifikasyon alanları izlenmektedir.
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Bu görüntüde kitlenin içsel karakteristikleri görünmektedir.noktasal kalsifiye Odaklar büyütülerek gösterilmiş.
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Buyuk,iyi sınırlı ,yuvarlak heterojen kitle SAK da görüldü.kitle karışık ekolu görünümde sınırları ile kc den net ayrılmakta
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Kitlenin ayrıntılı iç eko yapısını görüyorsunuz
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Büyümüş sağ adrenal bezi görmektesiniz. Görünen böbrek ve kc normal
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The significantly enlarged right adrenal gland is noted again
Belirgin büyümüş sağ adrenal bez tekrar görülmektedir.
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Sol adrenal bez de de buyume izlenmektedir. Görünen dalak normaldır.
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Buyumuş sol adrenal bez tekrar izlenmekte dalak ve sol hemidiyafragma Normal görünümde .
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Nonhomojen içerikle kalın duvarlı kitle görülmektedir.
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.kenar kalsifiye nonhomojen kitle
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Sağ A mass appears above the upper pole of the right kidney, abutting the external wall of the inferior vena cava. The mass is hypoechoic, slightly inhomogeneous
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The distended collecting system is noted again. No renal parenchymacan be identified, consistent with the atrophy due to long standing obstruction
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The cystic structure containing the highly echogenic material is noted again.
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The hugely distended right renal collecting system consisting of markedly dilated calyces and renal pelvis is noted again
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Vaka takdimi :
2 yaşında bayan hasta virilizasyon bulguları ile değerlendirildi.laboratuar bulguları Artmış testosteron ,dehidroepiandrostreon (DHEAS) VE 17 HİDROROKSİPROGESTERON seviyelerinde artış gösteriyordu. Çocuğun genetik olarak dişi olduğu doğrulandı.Bu yüzden semptomları heteroseksüel psödo prekoks puberte olarak tariflendi. Ve bu sendromun nedeni araştırmak için abdominal ultrsound uygulandı .
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Caption: Transverse scan of the right upper quadrant
Sağ bobreği üst polunde görülen bu kitle inferir vena cava komşuluğunda Hipoekoik ve hafifçe heterojen olarak izlendi.
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The mass is inhomogeneous, with a regular shape and it measures 7cm X 5.5cm There is a clear separation between the tumor and the right kidney.
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The mass presents poor vascularization
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Ayırıcı tanı :Çocukluk çağında testesteron sekrete eden adrenal kitleler Adrenal adenoma ve adrenal karsinoma dır.
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FINAL DIAGNOSISAdrenal Adenoma
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2 haftalık kız çocuğu ateş iştah kaybı ,ishal ,2 gündür kusma semptomatık Tedaviye yanıt vermedi. Hikayesinde zor doğum ,takibleri normal imiş. 38.4 ateş 160 atım /dk nb.ve kabulunde akut miyokardit ,sol pnomoni ve enterokolit şüphesi vardıVe laboratuar bulguları sodyum 117 ve potasyum 7.36 ile renal yetmezlik yada Mineralo kortıkal yetmezlik düşünüldü.
Vaka takdimi -2
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Hypoechoic mass with thick walls, displacing the ipsilateral kidney inferiorly with indentation of the upper pole.
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Thick walled mass with inhomogeneous contents
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Inhomogeneous mass with rim calcifications.
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The lesion is markedly reduced in size and appears inhomogeneous and exhibits extensive rim calcifications.
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Followup at 22 weeks. Ultrasound shows a small calcification above the upper pole of the kidney.
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DIFFERENTIAL DIAGNOSIS
Adrenal adenoma:, Cushing syndrome.
Adrenal cyst:..
Neuroblastoma:).
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FINAL DIAGNOSISRight adrenal hemorrhage
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60 yaşında erkek hasta hemoptizi ve goğüs x ray da plevral effüzyon saptandı .
Vaka takdimi 3
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A solid appearing, well-defined mass is seen in the right suprarenal region. The visualized liver and IVC appear normal.
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The well-defined, heterogeneous mass is noted again. It indents the IVC, but does not invade it.
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DIFFERENTIAL DIAGNOSISThis is a solid adrenal mass which could be due to cortical adenoma, metastasis, carcinoma, pheochromocytoma or ganglioneuroma
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FINAL DIAGNOSISThis is a metastatic solid adrenal mass. The patient had a malignant lung mass with pleural effusion
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55 yaşında hastanemiz endokrinoloji kliniğine routın fm de hematuri saptandı Yan ağrısı olmayan hastaya usg çekildi .
Vaka 5
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Hyperechoic, solid mass which attenuates sound. Located superior and slightly medial to the left kidney.
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Hyperechoic, solid mass (white arrows), which attenuates sound (black arrows), located superior and slightly medial to left kidney.
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DIFFERENTIAL DIAGNOSISAdrenal myelolipoma, retroperitoneal lipoma, exophytic renal angiomyolipoma,retroperitoneal liposarcoma
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FINAL DIAGNOSISLeft adrenal myelolipoma
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3 yaşında çocuk hastaya 2 aydır devam eden abdominal distansiyon için Usg çekildi.
Vaka 5
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A large, well-defined, rounded, heterogeneous mass is noted in the right upper quadrant. The mass has areas of mixed echogenicity and appears to have a discrete border that separates the mass from the liver.
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The internal characteristics of a section of the mass are displayed in this image. Also noted are multiple, small rounded hypoechoic structures in close vicinity to the mass, most likely representing metastatic nodes.
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DIFFERENTIAL DIAGNOSISRight adrenal tumor (neuroblastoma) versus a renal tumor (Wilm's tumor
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FINAL DIAGNOSISRight adrenal tumor- neuroblastoma
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Vaka 6
36 yaşında bayan hasta ıg a nefropatisine sekonder end stage renal hastalık ile Değerlendirildi.diyaliz esnasında müphem karın ağrısı şikayetleri mevcuttu.
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well-defined, hypoechoic rounded mass is seen in the region of the right adrenal gland, posterior to the inferior vena cava and indenting it. The visualized left lobe of the liver and the left hepatic vein appear normal
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The mass in the region of the right adrenal gland is noted again and shows well-circumscribed margins.
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The extrahepatic nature of the mass is well demonstrated in this image and the mass is seen displacing the inferior vena cava anteriorly.
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The mass exhibits no significant internal vascularity
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FINAL DIAGNOSISAdrenal adenoma
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Vaka 63 yaşında çocuk karın sağ kısımda ağrı nedeniyle usg incelemeye alındı.
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A well-defined, rounded, mildly lobulated, hypoechoic mass that is separate from the liver is noted in the right upper quadrant. The mass has areas of calcification and appears to displace the kidney downwards and medially.
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The mass is noted again displacing the right kidney and is distinctly separate from the kidney. The arrow points to the fine calcific specs seen within the mass
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The internal characteristics of the mass are displayed in this image. The fine and punctate nature of the calcifications is well demonstrated in this magnified image.
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This image shows the clear demarcation of the mass from the liver
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Right adrenal tumor- neuroblastoma versus a right renal tumor –Wilm’s tumor
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FINAL DIAGNOSISRight neuroblastoma
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Vaka 7
Bir günlük ambigus genitalıa sı olan cocuk hastanın cekilmiş sonografik görüntüleri
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The right adrenal gland is significantly enlarged. The visualized right kidney and liver appear normal
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The significantly enlarged right adrenal gland is noted again
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The left adrenal gland is also enlarged. The visualized spleen appears normal.
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The enlarged left adrenal gland is seen again. The visualized spleen and left hemidiaphgram appear normal.
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The visualized bladder appears normal. A tiny infantile uterus is seen with a small amount of fluid seen within the endometrial cavity.
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The findings of enlarged adrenals and ambiguous genitalia suggest adrenogenital syndrome
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FINAL DIAGNOSISThe findings of enlarged adrenals and ambiguous genitalia suggest adrenogenital syndrome
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