Nefrostomi ve üreteral stent komplikasyonları BT bulguları

Özet

Nefrostomi kateteri veya üreteral stent, obstrükte toplayıcı sistemi dekomprese etmek amacıyla kullanılır; kateter disfonksiyonu (tıkanıklık veya kaçak) tekrar müdahaleyi gerektirebilir. BT, cihazın kaliks-pelvis-üreter-mesane boyunca anatomik konumunu ve taş, hematom veya ürinoma gibi eşlik eden nedenleri gösterir. İdrar kaçağını saptamak için gecikmiş boşaltım görüntüleri gerekebilir; kontrastsız BT cihazı ve taşları, kontrastlı inceleme ise kanama veya doku hasarını değerlendirir. Enfekte obstrüksiyon ya da fark edilmeyen kanama hızla ağırlaşabileceğinden cihaz konumu ve böbrek çevresi ayrı ayrı incelenmelidir.

Faz ve pencere

Kontrastsız tanısal: Kontrastsız BT, akut hematomların değerlendirilmesinde kullanılır; aktif kanamanın lokalizasyonu için arteriyel faz eklenmelidir.
Arteriyel tanısal: İşlem sonrası belirgin kanama şüphesinde renal arter dalı çevresinde aktif kontrast ekstravazasyonu veya psödoanevrizma aranır.
BT ürografi tanısal: Gecikmiş boşaltım görüntülerinde kaliks, pelvis veya üreterden kontrastın ekstravazasyonu ve retroperitoneal ürinoma opasifikasyonu gösterilebilir.

Önerilen pencereler: Batın (G 400 / M 50), Yumuşak doku (G 400 / M 40), Anjiyo (G 600 / M 150).

BT bulguları

Kateterin yanlış yerleşimi idrar kaçağı ve perinefrik ürinoma gelişimi ile ilişkilendirilebilir.
Yan deliklerin veya ucun toplayıcı sistem dışında kalması, idrar kaçağı ve perinefrik ürinoma gelişimi ile ilişkilendirilebilir.
Üreteral stentler, üst sistem obstrüksiyonunda içsel dekompresyon sağlar; kateter disfonksiyonu tekrar müdahaleyi gerektirebilir.
Üreteral stentler görüntülemede doğru konumları ve olası komplikasyonları açısından değerlendirilmelidir.
Drenaj cihazı varlığına rağmen hidronefrozun sürmesi, ilerleyen obstrüksiyon veya stenoz açısından değerlendirilmeli ve neden araştırılmalıdır.
Kontrastsız görüntülerde perinefrik yüksek dansiteli koleksiyon hematomu destekler; arteriyel fazda iç kontrast odağı aktif kanama veya psödoanevrizma olabilir.
Gecikmiş görüntüde kontrastlanan perinefrik/retroperitoneal sıvı ürinomayı, toplayıcı sistemde opasifikasyonun gecikmesi ise drenaj bozukluğunu düşündürür.

Normalde

Normal nefrostomi kıvrımı genişlemiş renal pelviste oturur ve yan delikler toplayıcı sistemle ilişkili kalır; çift J stentin üst kıvrımı renal pelviste, alt kıvrımı mesane lümenindedir. Komplikasyon şüphesinde kontrastsız BT ilk başvuru görüntüleme modalitesi olarak değerlendirilir; aktif kanama için arteriyel faz eklenmelidir.

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 s0119; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Üreter taşı: cihaz doğru yerde olsa bile stent komşuluğunda hiperdens odak ve taşın üstünde üreter/pelvis genişlemesi görülür.
Aktif kanama: arteriyel fazda kontrast madde birikimi aktif kanamayı veya psödoanevrizmayı düşündürebilir.
Renal papilla nekrozu, genitoüriner tüberkülozun komplikasyonlarından biri olabilir.
Akut hematom: kontrastsız BT'de renal parankime göre hiperatuene (40-60 HU) koleksiyonlar akut hematomu destekler.

Tuzaklar

Distal çift J stent ucunun doğru konumu görüntülemede değerlendirilmelidir.
Üriner taş ölçümleri kontrastsız BT'de kullanılan pencereye göre değişebilir; büyütülmüş kemik pencere taş ölçümü için en doğru yöntemdir.
İşlem sonrası ince perinefrik kanama sık görülebilir; hematomun hacmi, arteriyel ekstravazasyon ve önceki görüntülere göre artış klinik anlamı belirler.

Kendini dene

Gecikmiş BT ürogramda toplayıcı sistemden perinefrik koleksiyona kontrast ekstravazasyonu görülüyor. Bu koleksiyon en olası nedir?
Cevabı göster
Ürinoma. Toplayıcı sistemden kontrast ekstravazasyonu idrar kaçağını gösterir; perinefrik koleksiyon ürinoma olabilir.
Üreteral stentlerin görüntülemede değerlendirilmesinde temel amaç nedir?
Cevabı göster
Stentin doğru konumunu ve olası komplikasyonlarını değerlendirmek. Stent görüntülemesinde doğru konum ve olası komplikasyonlar değerlendirilir.

İlgili konular

Abdominal dren ve perkütan kateter malpozisyonu

Kaynaklar

Bu sayfadaki 34 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 17 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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