这期说说膀胱结核的问题
膀胱结核（Tuberculosis of bladder）多继发于肾结核，少许由前列腺结核蔓延而来。最初的患侧输尿管开口处出现黏膜水肿，随后向其他部位扩散、蔓延至三角区并逐步累及整个膀胱。（关于肾结核及输尿管结核请查阅之前的课程）
Bladder TB (Tuberculosis of bladder) secondary to renal Tuberculosis, a little by prostate spread of Tuberculosis. The original side ureteral opening appear mucosal edema, then spread to other parts, spread to triangle and gradually down the bladder. (of renal tuberculosis and ureteral tuberculosis, please refer to previous courses)
X线平片对于早期膀胱结核价值有限，晚期膀胱容积减小，密度较高，有时可见膀胱壁线样钙化，称为‘结核性小膀胱’。如显示盆腔、腹腔内多发淋巴结钙化，则更有助于提示该病的诊断。
X-ray plain film for early value of bladder tuberculosis is limited, late bladder volume decreases, and density is higher, sometimes visible line bladder wall calcification, known as' n/med tuberculosis sex small bladder. Such as frequent displays pelvic and abdominal cavity lymph node calcification, more help to prompt the diagnosis of the disease.
在尿路造影X线片上，膀胱结核早期表现为膀胱容积有所缩小，边缘模糊欠光滑，痉挛明显时似憩室样改变。输尿管间嵴因炎性水肿而增宽，输尿管开口抬高变形。晚期膀胱壁广泛纤维化并严重痉挛，容积明显缩小，边缘不规则。逆行膀胱输尿管造影时，因输尿管与膀胱交界处括约肌功能失调，常出现明显的膀胱输尿管逆流现象，输尿管下端僵直、狭窄或呈漏斗状，伴输尿管、肾盂积水。
On the urinary tract imaging X-ray slice, bladder tuberculosis early performance for bladder volume shrinking, smooth, edge blur owe spasm like diverticulum sample change obviously. Ureteral between crest widened by inflammatory edema, ureteral opening up deformation. Late bladder wall extensive fibrosis and severe cramping, volume significantly narrowed, margin irregular. Retrograde bladder ureter imaging, due to the junction of ureter and bladder sphincter dysfunction, often appear obvious phenomenon of bladder ureter reflux, ureter lower rigidity, narrow or funnel shaped, with ureter and hydronephrosis.
CT不仅能显示非特异性膀胱壁增厚的表现，还能发现膀胱壁内沙粒样钙化。CT平扫可见膀胱壁不均匀或均匀增厚，外形轮廓不光整，结核性肉芽肿呈边界不清、密度不均的软组织结节或肿块影，中央有明显坏死；晚期的广泛纤维化导致膀胱容积明显缩小，膀胱壁明显增厚，有时可见膀胱壁条形钙化。。CT增强是结核性肉芽肿可出现中度强化，有时增厚的膀胱壁内膜可出现线样强化，如膀胱内充满对比剂，肉芽肿结节或肿块可形成充盈缺损影像，需与膀胱肿瘤鉴别。
CT can show not only nonspecific bladder wall thickening, calcification can also be found in the bladder wall sand sample. CT scan is thickening of bladder wall uneven or uniform, not only the figure of the whole, tuberculous granuloma, boundary is not clear and the uneven density of soft tissue nodules or mass shadow, central has obvious necrosis; Late extensive fibrosis leads to the bladder capacity significantly narrowed, bladder wall thickening obviously, sometimes visible bladder wall calcification. Bar. Tuberculous granuloma CT enhancement is moderate, there may be strengthened, and thickening of bladder wall lining can appear sometimes strengthen line samples, such as the bladder is full of contrast agent, the granulomatous nodules or masses can form filling defect image, with the identification of bladder tumor.
↑ 膀胱结核
CT增强扫描可见膀胱壁弥漫性增厚，呈轻度线样强化，膀胱体积缩小
膀胱结核的MRI表现与CT在形态上类似，亦可显示膀胱壁均匀或不均匀性增厚，膀胱容积缩小，边缘欠规整；晚期由于大量纤维组织增生或钙化形成，在T1WI和T2WI上均可表现为信号减低。
Bladder tuberculosis MRI manifestations and CT similar in shape, also can show bladder wall uniform or non-uniform thickening, bladder volume shrinking, edge owe neat; Late due to a large amount of fibrous tissue hyperplasia or calcification is formed, in can be shown as signal on T1WI and T2WI.
膀胱结核的诊断要点（The diagnosis of bladder tuberculosis points）：
1：膀胱刺激征：如尿频、尿急、尿痛、血尿和脓尿；尿频为进行性加重，早期为终末血尿，严重时全程血尿；脓尿有时呈米汤样
1: bladder irritation: such as frequency, urgency, urine pain, hematuria, and pyuria, Frequency for progression, early for terminal hematuria, serious when whole blood in the urine; Pyuria sometimes rice water sample
2：尿液检查有大量红细胞和脓细胞，结核分支杆菌培养60%为阳性
2: urine examination with a large number of red blood cells and pus cells, mycobacterium tuberculosis culture positive for 60%
3：排泄性尿路造影，约85%可显示一侧肾结核病变；膀胱造影可见膀胱边缘毛糙不整，容积明显缩小（可在50ml以下）
3: the discharge urinary tract imaging, about 85% can be displayed on one side of the renal tuberculosis; Bladder imaging visible edge of bladder coarse not whole, significant reduction (below 50 ml) volume
CT与MRI均可见膀胱壁增厚，有时可见壁内钙化影。膀胱结核主要需与膀胱癌和非特异性膀胱炎进行鉴别。
CT and MRI are visible in the bladder wall thickening, sometimes visible inside the wall calcification shadows. Bladder tuberculosis is main with the bladder cancer and nonspecific cystitis were identified.
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