Kateter ilişkili venöz tromboz ve fibrin kılıfı BT bulguları

Özet

Kateter, temas ettiği ven duvarında trombüs, lümen çevresinde fibrin kılıfı veya zamanla santral ven stenozu ve oklüzyonu oluşturabilir. Klinik bulgu vermeyen trombüsler onkolojik takip BT’sinde rastlantısal saptanabildiği için santral venler kateterin varlığı bilinse bile incelenmelidir. Venöz fazlı BT, opasifiye damar lümenindeki dolum defektini, tıkanıklığın uzunluğunu ve kollateral dolaşımı gösterir; fibrin kılıfının ince olması nedeniyle yalnız morfolojiyle kesin ayrım her zaman mümkün değildir. Tanınmayan santral tromboz ekstremite ve yüz ödemi, venöz basınç artışı, kateter işlev bozukluğu veya pulmoner emboliyle sonuçlanabilir.

Faz ve pencere

Venöz tanısal: Rutin evreleme BT’lerinde brakiyosefalik ven ve SVC gibi santral venlerdeki fibrin kılıfı ve tromboz varlığı değerlendirilir; trombozlar damar oklüzyon derecesine göre sınıflandırılır. Rutin evreleme BT’sinde kateter ilişkili tromboz ve fibrin kılıfı saptanabilir; bu bulgular asemptomatik hastalarda gözden kaçabilir.
Kontrastsız: Rutin BT’de kateter ilişkili tromboz ve fibrin kılıfı saptanabilir; bu bulgular asemptomatik hastalarda gözden kaçabilir.

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

BT bulguları

Kateter çevresinde eksantrik dolum defekti — kontrastlı lümenin bir bölümünü örten, kateterle temaslı trombüs görülür.
Ven oklüzyonu, trombüsün lümen çapını %50'den azına kadar daraltmasına göre minor, %50'den fazlasını kaplamasına göre moderat olarak derecelendirilir.
Trombozun neden olduğu darlık, lümen çapının %50'den azına kadar inmesi durumunda minor, %50'den fazlasını tutması durumunda moderat olarak sınıflandırılır.
Santral ven oklüzyonu veya stenozunda gelişen kollateral sirkülasyon, santral ven hastalığının radyolojik göstergesidir.
Fibrin kılıfı olasılığı — kateteri saran ince tübüler yumuşak doku veya kateter ucu çevresinde kılıf görünümü bulunabilir; sıradan BT kılıfı lümen trombüsünden kesin ayıramayabilir.
SVC sendromu paterni — SVC daralması/oklüzyonuna üst göğüs ve mediastinal kollateraller, bazen azygos sisteminde genişleme eşlik eder.
Trombozun yayılımı — aksiller/subklavyen venlerden brakiyosefalik venlere ve SVC’ye uzanım, opaklaşmış lümen sınırları boyunca kesit kesit izlenir.

Normalde

Santral venlerde fibrin kılıfı (≤2 mm) veya tromboza (>2 mm) bağlı hipodens dolum defekti bulunmaz. Santral ven hastalığı değerlendirilirken, ven lümenindeki dolum defektinin yanı sıra gelişen kollateral sirkülasyon da incelenmelidir.

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

Rutin BT’de kateter boyunca fibrin kılıfı ve trombozla ilişkili hipodens alanlar görülebilir; bu bulgular asemptomatik hastalarda gözden kaçabilir.
Fibrin kılıfı: kateteri dıştan saran ince kılıf şeklindedir ve ven duvarına yapışık mural trombüs gibi lümeni genişçe doldurmayabilir.
Kateter içi trombüs: dolum defekti kateter lümeninin içindedir; ekstraluminal venöz trombüs kateter ile damar duvarı arasında yer alır.
Tümör trombüsü: ven içindeki yumuşak doku kitleyle devamlılık gösterebilir ve kontrastlanabilir; kateter ilişkili pıhtı genellikle kontrastlanmayan dolum defektidir.
Mediastinal kitle veya cerrahi sonrası dıştan bası, kateter çevresinde intraluminal dolum defektine gerek kalmadan SVC lümenini daraltarak oklüzyon ve sendrom oluşturabilir.

Tuzaklar

Rutin BT’de kateter boyunca fibrin kılıfı ve trombozla ilişkili hipodens alanlar görülebilir; bu bulgular asemptomatik hastalarda gözden kaçabilir.
Küçük fibrin kılıfları rutin BT’de gözden kaçabilir; kateter disfonksiyonu olan kişide negatif BT, fibrin kılıfını dışlamaz.
Kollateraller yavaş gelişebildiğinden bulunmamaları akut trombozu dışlamaz; damar lümenini doğrudan izle.
Kateter boyunca fibrin kılıfı ve trombozla ilişkili ince hipodens alanlar rutin BT’de gözden kaçabilir; bu nedenle kateter çevresini dikkatle değerlendir.

Kendini dene

Kanserli hastalarda rutin evreleme BT’lerinde kateterle ilişkili olarak en sık rastlanan incidental bulgular hangileridir?
Cevabı göster
Fibrin kılıfı ve tromboz. S1 çalışmasında, kanserli hastalarda rutin BT’lerde fibrin kılıfı ve kateter ilişkili trombozun (CRT) sık görülen incidental bulgular olduğu belirtilmiştir.
Rutin BT’de kateter çevresinde ince tübüler hipodens alan saptandığında en olası tanı nedir?
Cevabı göster
Fibrin kılıfı. Kaynaklar, kateter boyunca ince hipodens alanların fibrin kılıfı ile uyumlu olduğunu ve rutin BT'de trombüsten ayrımın zor olabileceğini belirtir.

Bu konunun yer aldığı turlar

Tüpler, kateterler ve cihazların BT'de değerlendirilmesi

İlgili konular

Santral venöz kateter ucu malpozisyonu

Kaynaklar

Bu sayfadaki 35 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 13 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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