Servikal tüberküloz lenfadeniti BT bulguları

Özet

Servikal tüberküloz lenfadeniti, boyun lenf nodlarında granülomatöz enfeksiyon ve değişen derecelerde kazeöz nekroz oluşturan ekstrapulmoner tüberküloz tutulumudur. Kontrastlı boyun BT'si nodların dağılımını, merkezi nekrozu, çevre yumuşak dokularla ilişkisini ve birleşerek kitle oluşturup oluşturmadığını haritalar; görüntü tek başına etkeni kesinleştirmez. Kalın düzensiz halka, çok odacıklı düşük atenüasyon ve birleşik nod görünümü uygun klinik bağlamda tanıyı düşündürür. Kontrastlı BT ve MR, servikal lenf nodlarının yerini, tutulum paternini ve hastalığın uzamış bölgelerini göstererek yayılımın doğru değerlendirilmesine yardımcı olur.

Faz ve pencere

Kontrastlı tanısal: Kontrast sonrası nodlarda homojen boyanmadan santral düşük atenüasyonlu nekroz ve kalın, düzensiz çevresel boyanmaya kadar değişen görünüm izlenir; ilerlemiş hastalıkta çok odacıklı nekrotik nodlar birleşebilir ve çevre yağ planları silikleşebilir.

Önerilen pencereler: Yumuşak doku (G 400 / M 40), Mediasten (G 350 / M 50).

BT bulguları

Bir veya birden fazla servikal zincirde, sıklıkla birbiriyle komşu büyümüş nodlar bulunur; dağılımı üstten alt boyuna kadar kesitler boyunca izle.
Santral düşük atenüasyon kazeöz ya da liküefaktif nekrozu düşündürür; kontrastlanan periferik doku canlı granülasyon dokusunu temsil eder.
Rim işareti — nekrotik merkezin çevresinde kalın veya düzensiz kontrastlanan nodal kenar görülür.
Çok odacıklı merkezler ve arada seçilen ince septalar, tekdüze sıvı koleksiyonundan farklı nodal nekroz paterni oluşturur.
Komşu nodlar konglomere olabilir; ileri olguda tek tek nod sınırları ve yağ planları silikleşir.
Kronik veya tedavi sonrası nod içinde noktasal, kaba ya da kümelenmiş kalsifikasyon görülebilir.
İleri evrede kapsül rüptürüne perilenfatik inflamasyon ve komşu nodların füzyonu eşlik edebilir.

Normalde

Normal servikal nodlar zincir boyunca ayrı seçilir, çevre yağ planları korunur ve kontrast sonrasında nod içi belirgin nekrotik merkez veya kalın halka bulunmaz. HIV pozitif hastalarda lenfadenopati sıklıkla simetrik ve çoklu iken, HIV negatif hastalarda fokal ve asimetrik prezentasyon daha sık görülür.

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

Metastatik lenf nodları primer tümörün lenfatik drenaj zincirlerinde ortaya çıkar; santral nekroz, düzensiz kortikal kalınlaşma ve ekstranodal uzanım ayırıcı tanıda dikkat gerektiren bulgulardır.
Piyojenik apselerde merkezi non-enhanse alan ve çevrede hiperemik rim izlenirken, tüberkülozda düzensiz avasküler çekekler görülebilir.
Lenfoma, servikal tüberküloz lenfadenitini taklit edebilen ayırıcı tanılardandır; BT ve MR bulguları tek başına kesin tanı koydurmaz.
Atipik mikobakteriyel lenfadenit: nekrotik ve rim boyanan nodlar oluşturur; görüntü örtüşebilir, mikrobiyolojik doğrulama gerekir.
Sarkoidoz granülomatöz lenfadenitler arasında ayırıcı tanıya girer ve histopatolojik olarak non-kazeifiye granülomlarla karakterizedir.

Tuzaklar

Kalın düzensiz rim tüberkülozu düşündürür fakat metastazı dışlamaz; primer tümör alanını ve diğer nodal istasyonları aynı incelemede tara.
Birleşmiş nekrotik nodları tek derin boyun apsesi sanma; nodal zincir boyunca çok odacıklı yapıyı ve çevrede kalan nodları izle.
Kalsifikasyon geçirilmiş veya tedavi görmüş tüberkülozla uyumlu olabilir; kalsifik nod tek başına aktif enfeksiyon kanıtı değildir.
Tüberküloz lenfadenitte perinodal yumuşak doku değişikliği ve heterojenite izlenebilir; piyojenik apselerin merkezi non-enhanse alan ve çevresel hiperemi paterniyle bulgu örtüşmesi tanıyı zorlaştırabilir.

Kendini dene

Tüberkülozla uyumlu klinik bağlamda, birden fazla servikal nodda santral düşük atenüasyon, kalın düzensiz rim ve çok odacıklı görünüm var. En olası görüntüleme paterni nedir?
Cevabı göster
Tüberküloz lenfadeniti. Konglomere nodlar, santral nekroz ve kalın düzensiz rim tüberküloz lenfadenitini destekleyen bir patern oluşturur; ancak metastatik nodlar ve başka enfeksiyonlarla örtüşebilir. BT tek başına etkeni doğrulamaz; klinik ve mikrobiyolojik/histopatolojik bulgularla birlikte yorumlanır.
Servikal nodda nekroz var ve nod komşu yumuşak dokuda belirgin koleksiyonla devam ediyor. Hangi acil alternatif göz önünde tutulmalı?
Cevabı göster
Piyojenik nodal apse. Yaygın çevre inflamasyonu ve yumuşak dokuda sıvı koleksiyonuna devamlılık piyojenik apse olasılığını artırır. Kikuchi hastalığı ile reaktif hiperplazinin BT'de ayrımında konglomerasyon ve kontrastlanma paterni ayırt edici özellikler olarak bildirilmiştir.

İlgili konular

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 9 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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