Tiroid hipoplazisi/agenezisi BT bulguları

Özet

Tiroid disgenezisi doğuştan tek lobun, istmusun veya tüm bezin gelişmemesi ya da belirgin küçük kalmasını kapsar; BT'de çoğu kez başka nedenle çekilen boyun incelemesinde fark edilir. Hipoplazide ortotopik tiroid parankimi vardır ancak hacmi belirgin küçüktür; agenezide ortotopik parankim izlenmez. Bir lobun yokluğu, özellikle geçirilmiş hemitiroidektomi öyküsü bilinmiyorsa, doğumsal hemiageneziyi düşündürür; kalan lob kompansatuvar büyük olabilir. Kesitsel görüntüleme bez yatağını ve ektopik tiroid dokusunun olası yerlerini tarar, ancak fonksiyonel dokuyu kanıtlamak için tek başına yeterli değildir. Cerrahi sonrası değişikliği doğumsal yokluk sanmak ya da ektopik tek tiroid dokusunu gözden kaçırmak klinik yorum ve takip planını değiştirebilir.

Faz ve pencere

Kontrastsız tanısal: Boyun BT'sinde tiroid yatağında parankimin tek taraflı veya yaygın yokluğu, kalan lobun konturu ve istmusun bulunup bulunmadığı değerlendirilir.

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

BT bulguları

Bir tiroid lobunun beklenen yatakta seçilememesi, karşı lobun ise korunmuş olması hemiagenezi örüntüsüdür.
İstmus genellikle eşlik eden şekilde yoktur (%100) veya incelmiştir; orta hat yapıları ayrıca değerlendirilir.
Var olan lob diğer tarafa doğru genişleyebilir ve tek lob hacmi belirgin baskın hale gelebilir.
Kalan lobun medial ucu keskin bir sonlanma gösterebilir; bu morfoloji cerrahi kesilme hattından farklı olabilir.
Hyoid çevresi, dil kökü, tiroglossal trakt boyunca ve üst mediastende tiroid dansitesinde ektopik doku aranır.
Tiroidektomi yatağında klips, skar dokusu veya yumuşak doku değişikliği cerrahi öykü varsa yokluğu açıklar.
Kalan tiroid dokusunda nodül veya heterojen parankim bulunabilir; disgenezinin varlığı ayrı fokal patolojiyi dışlamaz.

Ölçütler ve sınıflamalar

Tek küçük CT serisinde, sol lob yokluğunda sağda kalan lobun medial ucu için hemiagenezi lehine bildirilen yardımcı açı ölçütü: > +30°

Normalde

Normal boyun BT'sinde tiroidin sağ ve sol lobları trakeanın iki yanında, istmusla birleşmiş halde seçilir. Aynı düzeylerde iki yatakta parankim bulunup bulunmadığını, istmusun sürekliliğini ve tek lobun medial ucunun düzgün doğal kontur mu yoksa cerrahi kesilme/skara mı karşılık geldiğini karşılaştır.

Normal BT ile kıyasla

Aynı bölgenin, kaynak veri setinde patoloji içermediği belirtilen bir BT incelemesini kesit kesit kaydırın; organ sınırlarını açarak anatomiyi hasta görüntüsüyle karşılaştırın. Küçük rastlantısal bulgular tümüyle dışlanmamıştır.

Kaynak: TotalSegmentator v2.01 veri seti (Wasserthal ve ark., Radiology: Artificial Intelligence 2023), CC BY 4.0, vaka s0622; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Hemitiroidektomi: lob yokluğuna cerrahi klips, skar, doku çekintisi veya kesilmiş bez yatağı eşlik edebilir.
Tiroid hipoplazisi: bez dokusunun eksik gelişmiş olduğu durumdur ve lobun tamamen yok olduğu ageneziden farklıdır.
Ektopik tiroid: yatakta bez dokusu yokken hyoid, dil kökü veya mediastende tiroid yoğunluklu doku görülebilir.
İnvaziv tiroid kitlesi sonrası bez kaybı: normal kontur yerine çevre dokulara uzanan düzensiz yumuşak doku ve komşuluk bozulması beklenir.

Tuzaklar

Bir tiroid yatağında doku izlenmemesi tek başına doğumsal yokluğu kanıtlamaz; hemiagenezi ameliyat sonrası değişiklik veya atrofiyle karıştırılabilir.
Dil kökü veya tiroglossal trakt boyunca yoğun doku, ortotopik bez yoksa işlevsel açıdan önemli tek tiroid odağı olabilir; BT iyot içeriğini gösterse de fonksiyonu ölçmez.
Kalan lobun kompansatuvar hacim artışı nodüler yapı değişimi veya neoplazi ile karıştırılmamalı; parankim yapısı ve düğümsel değişiklikler ayrı değerlendirilmelidir.

Kendini dene

Boyun BT'sinde sol tiroid lobu izlenmiyor, sağ lob korunmuş; bu bulgu hemiagenezi ile tiroidektomi sonrası durum arasında ayırım gerektirir. Bu görünüm öncelikle hangi gelişimsel durumu düşündürür?
Cevabı göster
Tiroid hemiagenezisi. Bir lobun yokluğu hemiageneziyle uyumludur; hemiagenezi ile tiroidektomi sonrası durumu ayırırken kalan lobun medial ucu ve ameliyat yatağına ilişkin görüntüleme bulguları değerlendirilir. Kalan lobun medial ucu ve tiroidektomi yatağına ilişkin bulgular, hemiagenezi ile cerrahi sonrası durumu ayırmaya yardımcı olabilir.
Ortotopik tiroid dokusu seçilmeyen hastada hangi inceleme bulgusu olası ektopik tiroid dokusunu düşündürür?
Cevabı göster
Dil kökünde tiroid yoğunluklu doku. Dil kökündeki tiroid yoğunluklu doku ektopik tiroid olabilir; görüntüleme yerleşimi gösterirken işlevsel değerlendirme için sintigrafi gibi yöntemler gerekir. Ektopik tiroid dokusu en sık dil kökünde yerleşir.

İlgili konular

Kaynaklar

Bu sayfadaki 35 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 13 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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