Trakeobronşiyal yabancı cisim aspirasyonu BT bulguları

Özet

Trakeobronşiyal yabancı cisim aspirasyonu çocuklarda ve yutma/öksürme refleksi bozulan erişkinlerde hava yolunu kısmen ya da tamamen tıkayabilir; akut obstrüksiyon acil, gecikmiş tanı ise tekrarlayan enfeksiyon ve kalıcı parankim hasarı riski taşır. Radyopak cisim doğrudan seçilebilir, ancak organik maddeler görünmeyebilir; BT bronş içi odağı ve dolaylı hava hapsi, atelektazi veya postobstrüktif değişiklikleri gösterir. BT, belirsiz grafi sonrası yabancı cismin yerini ve distal komplikasyonları haritalamada yararlıdır; klinik şüphe yüksekse negatif BT tek başına aspirasyonu dışlamaz. Ani bronş kesilmesi ve tek taraflı havalanma farkı küçük, gözden kaçabilir bir odağa yönlendirir.

Faz ve pencere

Kontrastsız tanısal: BT’de yabancı cisim doğrudan görülebilir; eşlik eden bulgular arasında konsolidasyon, atelektazi, plevral efüzyon ve bronş duvarı anormallikleri yer alabilir. BT, zor olgularda yabancı cismin konumunu üç boyutlu olarak değerlendirmeye yardımcı olabilir.

Önerilen pencereler: Akciğer (G 1500 / M -600), Mediasten (G 350 / M 50).

BT bulguları

Bronş lümeninde kemik, diş veya metal gibi yüksek atenüasyonlu yabancı cisim doğrudan görünür; radyolüsent cisim lümen içi yumuşak doku yoğunluğu olarak seçilebilir.
Ani bronş kesilmesi (interrupted bronchus sign), yabancı cisim aspirasyonunda görülebilen bir bulgudur.
Parsiyel valf mekanizması tek taraflı lobar/segmental hiperinflasyon ve ekspirasyonda hava hapsi oluşturur; tam tıkanma distal atelektaziye yol açabilir.
Distal mukus tıkacı, konsolidasyon, sentrilobüler nodüller veya bronş duvarı kalınlaşması tekrarlayan/postobstrüktif inflamasyonu gösterebilir.
Obstrüksiyonun uzun sürmesi distal bronşektazi, hacim kaybı ve kronik enfeksiyonla ilişkili değişiklikler yaratabilir.
Trakea veya ana bronşta yabancı cisim büyük hava yolu lümenini daraltıyorsa distalde hava geçişinin azalması ve iki akciğer arasında belirgin hacim farkı aranır.

Normalde

Şüpheli bronşu karşı tarafın eş düzey dalıyla kıyaslayarak ani kesilme, lümen içi cisim ve distal lob hacmi/atenüasyon asimetrisini ara.

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 s1278; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Mukus tıkacı: bronş lümeninde dallanan/tübüler yoğunluk oluşturabilir; distal atelektazi yapar ancak çevrede ayrı bir yabancı materyal yapısı seçilmez.
Endobronşiyal tümör: bronş duvarına bağlı yumuşak doku kitlesi, duvar kalınlaşması veya kontrastlanma ve kalıcı obstrüksiyon gösterebilir.
Astım veya küçük hava yolu hastalığı: yaygın/multifokal hava hapsi oluşturur, tek bronşta lümen içi odakla açıklanmaz.

Tuzaklar

Gıda parçaları radyolüsent olabilir; yabancı cisim doğrudan görünmüyorsa bronş kesilmesi ve distal hava hapsi gibi dolaylı bulgulara bakılmalıdır.
Mukus tıkacı yabancı cisim gibi endobronşiyal dolum oluşturabilir; tübüler dallanma, bronş duvarı ve tıkanıklığın distalindeki bulgularla birlikte değerlendir.
Endobronşiyal yabancı cisim şüphesinde tanıyı doğrulamaya yardımcı olmak için ek toraks ekspirasyon görüntüleri kullanılabilir.
Atelektazi tek başına aspirasyona özgü değildir; bronş lümenini üstten alta kadar incele ve tümör, mukus ya da sekresyon tıkacını ayır.

Kendini dene

Yemek sırasında öksürük sonrası BT’de sol ana bronşta cisim, distal solda hiperinflasyon var. En olası mekanizma?
Cevabı göster
Parsiyel valf obstrüksiyonu. Hava inspiryumda geçip ekspirasyonda çıkamadığında distal hiperinflasyon/hava hapsi gelişir; tam tıkanmada daha çok distal kollaps beklenir.
Radyolüsent cisim seçilmiyor; sağ alt lob bronşu aniden kesiliyor ve distal segmentte atelektazi var. En olası açıklama?
Cevabı göster
Gizli yabancı cisim. Radyolüsent organik yabancı cisim doğrudan görünmeyebilir. Fokal bronş kesilmesi ve distal atelektazi gizli yabancı cisim aspirasyonunu destekler; tam tıkanma da distal atelektazi yapar, bu bulgu tek başına cismin türünü kanıtlamaz ve mukus tıkacı da benzer obstrüksiyon oluşturabilir. Mekanik fokal obstrüksiyon bulguları, difüz hava yolu hastalıkları veya vasküler nedenlerle açıklanamaz; bu durum yerel bir tıkanıklığı (yabancı cisim veya mukus) düşündürür.

İlgili konular

Keskin, lineer ve radyolüsen yabancı cisim perforasyonu

Kaynaklar

Bu sayfadaki 33 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 7 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.