Klinik Atölye

Farinks ve larinks · Patoloji · Orta öncelik

Larengeal web

Laryngeal web

Larengeal web: yayımlanmış olgu görüntüsü, aksiyel kesit
Görüntü konuyu kısmen gösteriyor; bulgunun bir bölümü seçilebilir.

5 adım

Görüntü: Lamichhane S, Sarkar A, Maharjan S ve ark., “Posterior laryngeal web in an adult with GERD-associated globus pharyngeus: A rare case managed conservatively.”, 2025, Figure 2. PMC12648547 · doi:10.1093/omcr/omaf231 · CC BY 4.0. Değişiklik: kırpıldı, yeniden boyutlandırıldı, odak işaretleri eklendi.

Özet

Larengeal web, çoğunlukla anterior komissürde vokal kordları birbirine bağlayan ince ya da kalın membranöz dokudur; konjenital olabilir veya larengeal girişim, entübasyon ve travma sonrasında gelişebilir. BT, özellikle belirgin webde glottik hava sütunundaki köprüyü ve subglottik uzanımı gösterebilir; ince membranların doğrudan tanısında laringoskopi belirleyicidir. Boyun BT'si, glottik webin yapısını ve hava yolunda oluşturduğu daralamanın yerini belirlemek açısından ipuçları verebilir. Webin ya da eşlik eden subglottik stenozun fark edilmemesi, ses değişikliğinin ve hava yolu daralmasının doğru anatomik düzeyle açıklanamamasına yol açar.

Faz ve pencere

Kontrastsız tanısal
Kontrastsız ince kesitli boyun BT'sinde belirgin web, anterior glottiste yumuşak doku köprüsü ve bu düzeyde daralmış hava sütunu olarak görülür; ince web BT'de seçilemeyebilir ve tanısal doğrulama endoskopiye dayanır.

Önerilen pencereler: Yumuşak doku (G 400 / M 40), Akciğer (G 1500 / M -600).

BT bulguları

  • Anterior komissürde iki vokal kord arasında uzanan ince çizgisel veya kalın membranöz yumuşak doku köprüsü
  • Anterior glottik hava sütununda web kalınlığıyla orantılı daralma veya ön bölümde kapanma
  • Webin sagittal planda anterior-posterior derinliği ve glottis boyunca uzanımı
  • Koronal planda glottik membranın vokal kord düzeyinden supraglottik ya da subglottik alana devam etmesi
  • Kalın weble ilişkili krikoid içindeki subglottik daralma veya yelken biçimli uzanım
  • Vokal kordlarda eşlik eden skar, kontur düzensizliği ya da anterior komissürde cerrahi sonrası yapışıklık
  • Birlikte bulunan larengeal şekil anomalisi veya çok seviyeli hava yolu darlığı

Normalde

Normal glottiste anterior komissürde sağ ve sol gerçek vokal kordlar birleşir, ancak aralarında hava sütununu örten membranöz doku köprüsü bulunmaz. Aynı düzeyde anterior komissürün keskin birleşme noktasını, kordların karşılıklı serbest kenarlarını ve glottik hava sütununun ön-arka açıklığını web şüphesi olan kesitle kıyasla.

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

Anterior glottik tümör
asimetrik nodüler doku ve düzensiz kord kalınlaşması yapar; ince, düzgün membran köprüsü şeklinde değildir
Vokal kord paralizisi
kord hareketlerinin dinamik değerlendirilmesi gerekir; tanı laringoskopiyle konur.
Posterior glottik stenoz
skar ve yapışıklık posterior komissürde, aritenoidler arasında yerleşir
Subglottik stenoz
daralma kordların altında krikoid düzeyinde halka veya uzun segment biçimindedir; web glottik anterior komissüre odaklanır

Tuzaklar

  • Web sabit bir yumuşak doku köprüsüdür; fonasyon veya yutkunma sırasında vokal kordlar hareket etse de web konumu değişmez, bu da onu dinamik kord pozisyonlarından ayırır.
  • İnce membran BT'nin uzaysal çözünürlüğünün altında kalabilir; BT'de görünmemesi webi dışlamaz.
  • Kalın webin subglottik uzanımı eşlik eden stenozu gizleyebilir; glottik seviyede bulguyu gördükten sonra krikoid altını da sagittal ve koronal planda tara.
  • Anterior glottik kitlenin kısa segment görünümü membran sanılabilir; nodüler/asimetrik doku ve kord infiltrasyonu varsa tümör olasılığını ayrıca belirt.

Kendini dene

  1. BT'de anterior komissürden geçen ince doku köprüsü glottik hava sütununu daraltıyor; posterior komissür açık. En olası tanı nedir?

    Cevabı göster

    Anterior larengeal web. Anterior komissürde sabit membranöz köprü web için tipiktir. Posterior skar aritenoidler arasında, paralizi kord pozisyonunda değişiklik yapar; papillom ise düzensiz papiller doku görünümündedir.

  2. Çocukta glottik web şüphesi var; ince membranöz webin kesin değerlendirmesi için hangi yöntem gerekir? Bu görüntü neyi gösterir?

    Cevabı göster

    İnce web BT'de görünmeyebilir. İnce web BT çözünürlüğünün altında kalabileceğinden negatif BT dışlayıcı değildir; doğrudan değerlendirme endoskopiyle yapılır. Açık hava sütunu tek başına paralizi veya subglottik hemangiomu doğrulamaz; paralizi kord hareketlerinin laringoskopik değerlendirilmesiyle, hemangiom ise kontrastlanan subglottik lezyon olarak değerlendirilir.

İlgili konular

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 8 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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