目的探讨头孢菌素相关性尿路可逆性结石的CT影像表现。方法回顾性分析本院7例近期使用头孢菌素后尿路出现可逆性结石患者的病例资料。所有患者均有静脉注射头孢菌素用药史,疗程1-3 d,用药后1-6 d全腹部CT平扫显示尿路多发高密度可逆性结石影,6例停药后7-16 d腹部CT随诊显示尿路可逆性结石消失（4例）或明显减少（2例）,1例行手术治疗。在CT图像上,观察可逆性结石的部位、数量、形态、密度和伴随征象,并结合相关文献进行分析。结果7例患者中,肾结石7例,双侧发生5例,单侧2例,结石均为多发,呈结节状或泥沙状;输尿管结石6例,双侧发生1例,单侧5例,其中5条输尿管各发生2枚,2条单发,结石共12枚,2枚呈结节状,10枚呈圆柱状或条状;膀胱结石3例,单发2例,呈小结节状,多发1例,呈泥沙状;2枚结石密度不均匀,其他结石密度较均匀,各个结石之间密度不甚一致,全部结石CT值范围为47-667 HU;6例患者共7条输尿管发生梗阻性尿路轻度或中度积水。结论头孢菌素相关尿路可逆性结石由于其形成时间短,结构松散,在尿路中容易铸型,CT表现具有一定特点。在怀疑头孢菌素相关尿路可逆性结石时,应注意询问用药史并应在短期内影像学复查,以便明确诊断,避免不必要的治疗并选择适当的治疗方法。
Objective To investigate the CT features of cephalosporin-induced reversible urolithiasis. Methods The medical records of 7 patients with urinary tract stones occurring after cephalosporin treatment were reviewed. Multiple calculi were found on abdominal CT 1-6 days after administration of cephalosporin for 1-3 days. The calculi disappeared（4 patients） or were diminished（2） on abdominal CT after drug withdrawal for 7-16 days. One patient required surgical removal of stones. The location,number, shape, density, and concomitant features of the stones were analyzed. Results Renal calculi were found in all the 7cases, with 5 bilateral and 2 unilateral. All renal caculi were multiple and presented as nodular or sand-like. Ureteral stones were detected in 6 cases, 1 bilateral and the other 5 unilateral. Of all the 7 ureters involved, double stones were found in 5 ureters and single ureteral stones in 2 ureters. In the 12 stones, 2 were nodular, 10 were cylindrical or bar-type. 3 cases combined with bladder stones, of which, 2 were single nodular and 1 multiple sand-like. 2 of the stones presented uneven density. However, the others were relatively homogeneous. Densities of all the stones were different, ranging from 47 up to 667 HU. Urinary obstruction and sequel hydronephrosis were seen in 6 patients totally 7 ureters. Conclusion Cephalosporin-induced reversible urolithiasis is often staghorn in shape because of short formation time and loose structure. Drug history and short-interval CT follow-up can aid detection and appropriate treatment.
Journal of Diagnostic Imaging ＆ Interventional Radiology