Sinonazal hemanjiom ve lobüler kapiller hemanjiom

Özet

Lobüler kapiller hemanjiom, septum veya konka mukozasında gelişebilen benign vasküler nodüldür ve tekrarlayan burun kanaması ya da tıkanıklıkla başvurabilir. Kontrastsız BT lezyonun yerini ve kemikle ilişkisini gösterir; kontrastlı BT'de yoğun boyanma vasküler niteliği destekler. Küçük lezyonda kemik değişikliği olmayabilir, kemikte yer değiştirme, remodelasyon veya erozyon görülebilir. Hipervasküler kitleyi polip olarak adlandırmak ve çevre kemik değişikliğini incelememek tanısal ayrımı geciktirebilir.

Faz ve pencere

Kontrastsız tanısal

Septum veya konka mukozasından çıkan yumuşak doku nodülü ve komşu kemik korteksinin yer değiştirmesi izlenebilir; küçük lobüler kapiller hemanjiomda kemik değişikliği bulunmayabilir.

Kontrastlı tanısal

Kapiller ve lobüler kapiller hemanjiomlarda BT’de erken fazda orta veya belirgin kontrastlanma görülebilir ve bu kontrastlanma gecikmiş fazda azalabilir. Kapiller ve lobüler kapiller hemanjiomlarda BT’de erken fazda orta veya belirgin kontrastlanma görülebilir ve bu kontrastlanma gecikmiş fazda azalabilir.

BT bulguları

• Nazal septum ön kısmı veya alt konkada sık görülen, iyi sınırlı lobüleli yumuşak doku nodülü.
• Kontrastlı görüntüde lezyonda yoğun veya lobüler kontrast tutulumu.
• Küçük kitlede komşu kemik korteksinin korunması.
• Komşu kemikte yer değiştirme veya erozyon görülebilir; erozyon tek başına malignite kanıtı değildir.
• Nazal kavite hava yolunda lokal daralma ve posterior koanaya doğru uzanım.
• Kapiller ve lobüler kapiller hemanjiomlarda BT’de erken fazda orta veya belirgin kontrastlanma görülebilir ve bu kontrastlanma gecikmiş fazda azalabilir; kontrastlanma özellikleri histolojik tiplemeye katkı sağlayabilir.
• Maksiller sinüs ve etmoid hücrelerde eşlik eden sekresyon veya mukoza kalınlaşması.

Normalde

Normal nazal kavitede septum orta hattadır; konkaların kemik çekirdekleri ince, düzgün ve üzerindeki mukoza simetriktir. Karşı taraf septum ve konka konturlarını kıyaslayarak nodülün yapışma yerini, kontrastlanmasını ve komşu kemikte bası olup olmadığını ayırt et.

Ayırıcı tanı

Juvenil nazofaringeal anjiofibrom

posterior nazal/nazofarenks merkezli, pterigopalatin fossa genişleten vasküler kitle.

Devrik papillom

BT ve MR’da karakteristiki konvolüze serebriform deseni gösterir; kemik yıkımı ve lokal agresyon ile ayrılır.

İnflamatuvar polip

tek taraflı nazal kitlelerin ayırıcı tanısında değerlendirilir.

Sinonazal melanom

ilerleyici tek taraflı burun tıkanıklığı, tekrarlayan epistaksi ve kemik invazyonu ile seyreden agresif bir mukozal tümördür.

Sinonazal malignite

düzensiz kemik yıkımı ve komşu doku infiltrasyonunun kuşkulanıldığı agresif bir süreçtir.

Tuzaklar

• Belirgin kontrastlanma tek başına hemanjiom tanısı değildir; tümörün septum/konka kökenini ve posterior pterigopalatin alanı incele.
• Lobüler kapiller hemanjiomda komşu kemikte yeniden şekillenme veya erozyon olmayabilir; kemik değişikliklerinin yokluğu tanının dışlanması için yeterli değildir.
• Kontrastsız incelemede yumuşak doku diğer poliplerle benzer görünebilir; damar niteliği için kontrastlı inceleme ve klinik kanama öyküsü önemlidir.
• Belirgin vasküler nazal kitlelerde görüntüleme lezyonun vasküler özelliklerini ve yayılımını değerlendirmeye yardımcı olur; yüksek vaskülarite biyopsi sırasında kanama riski taşıyabilir ve juvenil nazofaringeal anjiofibrom ayırıcı tanısında sfenopalatin foramen ile pterigopalatin fossa ilişkisi incelenmelidir.

Kendini dene

1. Ön nazal septumda polilobüle ve temasla kanayan bir lezyon görülüyor; BT bulguları lobüler kapiller hemanjiomu düşündürmektedir. En olası tanı hangisidir?

   • Lobüler kapiller hemanjiom
   • İnflamatuvar polip
   • Retansiyon kisti
   • Osteom
   Cevabı göster

   Lobüler kapiller hemanjiom. Ön septumdaki polilobüle, temasla kanayan lezyon ve BT bulguları lobüler kapiller hemanjiomu akla getirir; kesin tanı histopatolojik inceleme ile konur.

2. Posterior nazofarenks kitlesi pterigopalatin fossayı genişletip maksiller arka duvarı öne itiyor. Hangi lezyon öne çıkar?

   • Juvenil anjiofibrom
   • Lobüler kapiller hemanjiom
   • Konka bülloza
   • Maksiller antrolit
   Cevabı göster

   Juvenil anjiofibrom. Posterior nazal köken ve pterigopalatin fossa genişlemesi juvenil anjiofibrom için tipiktir; lobüler kapiller hemanjiom çoğunlukla septum veya konka kaynaklıdır.

İlgili konular

• Juvenil nazofaringeal anjiyofibrom

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 13 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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