Kronik/tekrarlayan sialadenit

Özet

Kronik veya tekrarlayan sialadenit, yineleyen kanal tıkanması ya da inflamasyon sonrasında bez parankimi ve kanal ağında gelişen kalıcı değişiklikleri kapsar. BT ve ultrasonografi, bezlerde büyüme veya atrofi, apse, duktal dilatasyon, kistler, taşlar ve kalsifikasyonları gösterebilir; görüntüleme bulguları hastalığın şiddetine ve evresine göre değişir. Aktif alevlenme bulgularını kronik atrofi ve yağlı dönüşümden ayırmak, tek görüntülemenin hastalık aktivitesini olduğundan fazla göstermesini önler. Fokal kitle veya apseyi kronik değişiklik sanmak, başka tanıların araştırılmasını geciktirebilir.

Faz ve pencere

Kontrastsız tanısal

Kronik dönemde bezde hacim kaybı, yağlı dönüşüm, parankim içi küçük kalsifikasyonlar ve kanal boyunca yüksek atenüasyonlu kalküller araştırılır; ana kanal ektazisi eşlik edebilir.

Kontrastlı

Kontrastlı görüntüleme ve ultrasonografi, bezde büyüme, apse varlığı ve parankimal heterojeniteyi değerlendirmeyi sağlar; kanal ağının detaylı haritalandırılması için alternatif yöntemler gerekebilir.

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

BT bulguları

• Heterojen parankim özsavurganlığı izlenebilir; tutulum her iki bezi de etkileyebilir veya tek taraflı olabilir.
• Kronik hasarda bez hacminde azalma ve parankimde yağlı dönüşüm.
• Ana kanalın düzensiz genişlemesi ve hiler/proksimal kanal ektazisi.
• Kanal içinde taş veya parankimde distrofiye bağlı küçük kalsifikasyonlar.
• Aktif alevlenmede bez büyümesi, kontrastlanma heterojenliği ve çevre yağ dokusunda yeni çizgilenme.

Normalde

Parotis ve submandibular bezlerde görüntüleme atrofi, kanal genişlemesi, kist, taş veya kalsifikasyon gösterebilir. Kıyasta hacim kaybı veya granüler parankim ile kanal kalibrasyonu ve çevresel inflamasyonun yeni olup olmadığına bakılır.

Ayırıcı tanı

Sjögren hastalığı

iki taraflı parotislerde çok odaklı kistik/solid değişiklikler ve ileri evrede atrofi görülebilir; klinik sicca ve diğer bez bulguları ayrımda önemlidir.

IgG4 ilişkili sialadenit

sıklıkla iki taraflı, simetrik submandibular büyüme ve homojen kontrastlanma gösterir.

Akut enfeksiyöz sialadenit

kronik atrofi yerine akut bez büyümesi ve belirgin yeni periglandüler inflamasyon öne çıkar.

Sialolitiazis

kanal içi kalsifiye odak doğrudan seçilir; taş olmadan darlık olasılığı kesitsel BT'de dışlanamaz.

Tükürük bezi neoplazisi

kronik yaygın parankim değişikliğinden farklı olarak sınırlı solid kitle veya infiltratif odak oluşturabilir.

Tuzaklar

• Erken kronik hastalıkta BT normal olabilir; normal görünüm öyküyle desteklenen tekrarlayan kanal hastalığını dışlamaz.
• Parankim kalsifikasyonunu kanal taşıyla eş tutma; lümenle ilişkisini ve kanal genişlemesini ayrı ayrı doğrula.
• Parankimde yağlı dönüşüm veya fibrozis uzun süreli hasarı gösterebilir, fakat bu görünüm mevcut aktif alevlenmeyi tek başına kanıtlamaz.
• Kronik sialadenitte küçük kistik odaklar görülebilir; belirgin solid bileşen veya büyüyen fokal kitle varsa yalnızca kronik inflamasyonla açıklanamaz.

Kendini dene

1. Tekrarlayan şişlik öyküsünde parotis hacmi azalmış, parankim granüler ve ana kanal düzensiz genişlemiştir. En olası süreç nedir?

   • Kronik sialadenit
   • Akut viral parotit
   • Warthin tümörü
   • IgG4 ilişkili hastalık
   Cevabı göster

   Kronik sialadenit. Hacim kaybı, granüler parankim ve düzensiz kanal ektazisi kronik hasar paternidir. Viral parotit akut büyüme, Warthin fokal kitle, IgG4 ilişkili hastalık çoğunlukla homojen submandibular büyüme yapar.

2. BT görüntülerinde Wharton kanalında belirgin kalsifiye taş bulunmazken, kanal boyunca yüksek atenüasyonlu materyal izlenmektedir. Bu bulgu en çok hangi patolojik madde ile ilişkilidir?

   • Viskoz eozinofilik müsin
   • Kalsifiye sialolit
   • Venöz flebolit
   • Tonsil taşı
   Cevabı göster

   Viskoz eozinofilik müsin. Eozinofilik sialodoşitte kanal içinde tutulan viskoz eozinofilik müsin, kalsifiye taş olmaksızın BT'de yüksek atenüasyonlu materyal olarak görünebilir.

İlgili konular

• Akut sialadenit
• Obstrüktif sialadenit
• Sialolitiazis

Kaynaklar

Bu sayfadaki 34 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 6 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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