Ektopik tiroid dokusu

Özet

Ektopik tiroid, embriyolojik iniş yolu boyunca normal pretrakeal yatağın dışında bulunan tiroid dokusudur; en sık dil kökünde, daha seyrek boyun veya mediastende görülür. BT, kitlenin anatomik yerini, normal tiroid yatağının boş olup olmadığını, komşu hava yolu ve yutakla ilişkisini ve iyot içeriğine bağlı dansite-kontrastlanma benzerliğini gösterir. Ektopik odak tek işlevsel tiroid dokusu olabilir; BT bunu işlevsel olarak doğrulamaz ve sintigrafi gerekebilir. Lezyon yanlışlıkla lenf nodu, kistik kitle veya tümör sanılıp çıkarılırsa hastanın işlevsel tiroid dokusu kaybedilebilir ya da hava yolu basısı fark edilmeyebilir.

Faz ve pencere

Kontrastsız tanısal

Ektopik tiroid odağı, komşu kaslardan daha yüksek atenüasyonlu yumuşak doku şeklinde seçilebilir; normal tiroid yatağında bez bulunmaması ve odağın iniş hattındaki konumu tanıyı destekler.

Venöz tanısal

Venöz fazda odak çoğunlukla belirgin, bazen homojen kontrastlanır ve ortotopik tiroidle benzer yumuşak doku görünümü verir; kalsifikasyon veya dejenerasyon varsa görünüm heterojenleşebilir.

Önerilen pencereler: Yumuşak doku (G 400 / M 40), Kemik (G 1800 / M 400).

BT bulguları

• Dil kökü odağı — foramen cecum çevresinde, dil kökü orta hattında tiroid benzeri solid yumuşak doku.
• Orta hat iniş yolu kitlesi — dil kökü ile hyoid ve tiroid yatağı arasında kraniokaudal hatta odak bulunabilir.
• Ortotopik tiroid yokluğu — boyun ön kompartımanında tiroid lobları seçilemeyebilir; odak tek bez dokusu olabilir.
• Tiroid benzeri atenüasyon — kontrastsız görüntüde kaslardan daha yoğun yumuşak doku görünümü iyot içeriğini yansıtabilir.
• Belirgin kontrastlanma — ektopik parankim iyotlu kontrastı yoğun tutar ve normal tiroid dokusuna benzer davranır.
• Mediastinal ektopik odak — ön veya paratrakeal mediastende, servikal tiroidden ayrı yumuşak doku kitlesi görülebilir.
• Yerel bası — dil kökü, farinks, trakea veya mediastinal damarlara göre kitlenin lümen ve komşuluk etkisi belirlenir.

Normalde

Normal boyun BT'sinde tiroid lobları trakeanın ön-yanında, istmusla birleşmiş halde izlenir; dil kökü ve foramen cecum çevresinde ayrı tiroid benzeri solid doku bulunmaz. Odağın yoğunluğunu ortotopik bez ve komşu kasla kıyaslayın, ardından normal tiroid yatağının dolu olup olmadığını ve arada embriyolojik iniş hattı boyunca ek odak bulunup bulunmadığını kontrol edin.

Ayırıcı tanı

Tiroglossal kanal kisti

hyoid çevresinde orta hatlı, sıvı atenüasyonlu ve sıklıkla kistik lezyondur; ektopik tiroid ise solid ve iyot içeren dokudur.

Ektopik tiroid dokusu dil kökü tabanında yerleşebilir.

Vallekula kisti, hava yolu basısına yol açabilen bir lezyondur.

Paratiroid adenomu

genellikle tiroid arka komşuluğunda odaklanır; ektopik tiroidin embriyolojik orta hat yerleşimi ve tiroid dokusuna benzer yoğunluğu tipik değildir.

Mediastinal lenf nodu veya timik kitle

mediastinal anatomik kompartımanda yer alır ancak ortotopik tiroidle benzer spontan yüksek atenüasyon ve belirgin iyotlanma ektopik dokuyu destekler.

Tuzaklar

• Normal tiroid yatağını ayrıca aramadan dil kökü kitlesini yalnızca kitle olarak tanımlamayın; ortotopik bezin yokluğu ektopik tiroid olasılığını belirgin artırır.
• Yoğun kontrastlanma tek başına ektopik tiroid tanısı koydurmaz; benzer özellikteki paratiroid veya hipervasküler kitleler ve sintigrafik doğrulama gereksinimi akılda tutulmalıdır.
• Servikal tiroidin aşağı uzanımını gerçek mediastinal ektopiden ayırın; kesitler boyunca bezle devamlılık varsa aşağı sarkan guatr daha olasıdır.

Kendini dene

1. Dil kökü orta hattında tiroidle benzer yoğunlukta ve belirgin kontrastlanan solid kitle var; pretrakeal yatakta bez seçilmiyor. En olası tanı nedir?

   • Lingual ektopik tiroid
   • Vallekula kisti
   • Lingual tonsil hipertrofisi
   • Tiroglossal kanal kisti
   Cevabı göster

   Lingual ektopik tiroid. Dil kökü orta hat yerleşimi, tiroid benzeri atenüasyon-kontrastlanma ve ortotopik bez yokluğu lingual ektopik tiroidi destekler. Kistler sıvı içeriklidir; tonsil hipertrofisi ise lenfoid dokunun yüzeyel kabarıklığıdır.

2. Üst mediastende tiroid benzeri kitle görülüyor. Servikal tiroidle devamlılık saptanırsa hangi tanı daha olasıdır?

   • Aşağı uzanan servikal guatr
   • Primer mediastinal lenfoma
   • Ektopik paratiroid adenomu
   • Timik kist
   Cevabı göster

   Aşağı uzanan servikal guatr. Servikal bezden kesintisiz biçimde aşağı uzanma, gerçek ayrı ektopik dokudan çok substernal uzanımlı guatrı destekler. Servikal tiroid bezinin devamlı biçimde aşağı uzanması, substernal uzanımlı guatrı destekler.

Kaynaklar

Bu sayfadaki 37 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 3 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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