Subglottik stenoz

Özet

Subglottik stenoz, özellikle entübasyon veya trakeostomi öyküsü bulunanlarda kalıcı hava yolu daralmasının nedenidir; idiyopatik ve konjenital biçimleri de vardır. İnce kesitli boyun BT'si dar segmentin yerini, uzunluğunu, lümen şeklini ve kıkırdak desteğini göstererek bronkoskopik incelemeyi tamamlar. BT'de stenozun uzunluğu ve hava yolu boyutları üç boyutlu rekonstrüksiyonlarla ölçülebilir. Daralmanın atlanması stridorun yanlış biçimde alt solunum yolu hastalığına bağlanmasına ve hava yolunun kritik darlığının fark edilmemesine neden olabilir.

Faz ve pencere

Kontrastsız tanısal

Boyun BT'si subglottik skarın anatomik karakterizasyonunda kullanılır; iSGS'de BT, krikoid düzeyinde çevresel skar dokusunu gösterebilir.

BT bulguları

• Gerçek vokal kordların hemen altından başlayan subglottik lümen daralması
• İdiyopatik subglottik stenoz, krikoid düzeyinde çevresel fibrotik halka şeklinde daralma oluşturabilir.
• Boyun BT'sinin sagittal görüntüleri ve üç boyutlu rekonstrüksiyonu, subglottik stenozun yerini ve uzanımını göstermeye yardımcı olabilir.
• Aksiyel BT, subglottik skarın anatomik karakterizasyonunda temel görüntüleme yöntemidir.
• Entübasyon sonrası subglottik stenozda BT ve endoskopide submukozal hasara bağlı özgül olmayan fibrotik kalınlaşma görülebilir.
• Krikoid kıkırdak nekrozunda BT'de kıkırdak parçalanması veya santral laminada hipodensite görülebilir.
• Stenozun glottise, servikal trakeaya veya stoma düzeyine doğru devam etmesi
• Boyun BT'sinde stenozun anatomik yeri ve uzanımı değerlendirilebilir.

Ölçütler ve sınıflamalar

Myer–Cotton

Myer–Cotton sınıflaması subglottik stenozu derecelendirmek için kullanılır. BT, subglottik skarın anatomik karakterizasyonuna yardımcı olur; stenozun endoskopik değerlendirmesi ayrıca yapılır.

McCaffrey

Normalde

Normal subglottik hava sütunu gerçek vokal kordların altında, krikoid halka içinden servikal trakeaya kesintisiz ve düzgün biçimde devam eder. Aynı hastada stenozun üst ve altındaki lümen çapını ve aksiyel kesitte kesit alanını, krikoid kıkırdağın simetrisini ve darlığın glottis-trakea yönündeki uzunluğunu karşılaştır.

Ayırıcı tanı

Subglottik hemangiomda laringoskopide düzgün, yuvarlak, vasküler görünümlü submukozal lezyon; kontrastlı BT'de hava yolu lümenini örten kontrastlanan lezyon görülebilir.

Konjenital larengeal webler tipik olarak anterior yerleşimlidir.

Larengeal tümör

asimetrik kitle, mukozal düzensizlik veya kıkırdak invazyonu yapabilir; düzgün skar halkası görünümünden ayrılır

Trakeomalazi

sabit skar halkası yerine solunum fazıyla değişen duvar kollapsı vardır; statik BT dinamik hastalığı dışlamaz

Bilateral vokal kord paralizisi

daralma glottis düzeyindedir ve vokal kordların pozisyon/hareket kusuru eşlik eder

Granülomatozis ile polianjiit, subglottik stenozla ilişkili sistemik otoimmün hastalıklardan biridir.

Tuzaklar

• Stenozun yönelimi farklı olsa da hava yolu boyutları üç boyutlu olarak ölçülebilir.
• Trakeal stent veya endotrakeal tüp varlığında daralan segmentin sınırları ve komşu normal hava yolu, cihazın proksimal ve distal uçları dışında ayrıca değerlendirilmelidir.
• Myer–Cotton derecesi alan kaybına dayanır ve uzunluğu ya da karmaşık çok seviyeli hastalığı kodlamaz; BT raporunda uzunluğu ve uzandığı alt bölgeleri ayrıca belirt.
• Trakeal lezyonların değerlendirilmesinde dinamik toraks görüntülemesi kullanılabilir; trakeomalazi destekleyici trakeal kıkırdağın gevşekliğiyle karakterizedir.

Kendini dene

1. Subglottik stenozda daralma hangi anatomik bölgede yer alır?

   • Glottisin hemen altındaki proksimal hava yolu
   • Nazofarenks
   • Ana bronşlar
   • Alveoller
   Cevabı göster

   Glottisin hemen altındaki proksimal hava yolu. Subglottik stenoz, glottisin hemen altındaki proksimal hava yolunda daralma olarak tanımlanır.

2. Kaynağa göre subglottik stenozu derecelendirmek için hangi sınıflama kullanılır?

   • Myer–Cotton
   • Cohen
   • Bogdasarian
   • Lano-Netterville
   Cevabı göster

   Myer–Cotton. Kaynak, subglottik stenoz için Myer–Cotton sınıflamasını belirtir.

İlgili konular

• Larengeal web
• Tedavi sonrası larengeal değişiklik ve kondroradyonekroz

Kaynaklar

Bu sayfadaki 39 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 25 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.