Retansiyone veya embolize kateter/kılavuz tel parçası

Özet

Santral venöz kateter veya kılavuz tel işlemi sonrası kateterin dışarıda kalan segmentinde kısalma, bağlantı kesintisi ya da yeni aritmi varsa intravasküler yabancı cisim düşünülür. BT, metalik parçanın damar ve kalp odacıklarına göre seyrini, ucunun miyokarda temasını ve eşlik eden trombüs ya da perforasyonu anatomik olarak gösterir. Kateter parçası venöz sistemden sağ kalp ve pulmoner arter dallarına ilerleyebilir; grafi çoğu kez ilk saptama aracıdır, BT ise konumu ve çevre komplikasyonları netleştirir. Tanı gecikirse parça tromboz, aritmi, enfeksiyon, damar/kalp duvarı hasarı veya pulmoner embolik komplikasyona neden olabilir.

Faz ve pencere

Kontrastsız tanısal

Kontrastsız göğüs BT'sinde metalik lineer parça kateterin anatomik yolunu izler; brakiosefalik ven, vena kava, sağ atriyum/ventrikül ve pulmoner arter içindeki konumu MPR'de kesintisiz takip edilir.

Venöz tanısal

İV kontrastlı venöz incelemede parçayı çevreleyen kontrastlı lümeni, eşlik eden dolum defektini veya damar dışı ekstravazasyonu araştır; kalp duvarı perforasyonu kuşkusunda serbest ucun miyokardla ilişkisini farklı düzlemlerde doğrula.

Önerilen pencereler: Mediasten (G 350 / M 50), Anjiyo (G 600 / M 150).

BT bulguları

• Vena kava, sağ atriyum, sağ ventrikül veya pulmoner arter içinde damar seyrine uyan ince lineer metalik yabancı cisim
• Kateterin cilt altı port veya venöz giriş tarafında beklenen devamlılığının kesilmesi; serbest distal parçayı damar boyunca izle
• Parça ucunun sağ atriyum/ventrikül duvarına dayanması veya miyokard dışına taşması; kalp duvarı ve perikardı hedefli incele
• Yabancı cisim çevresinde kontrast dolum defekti veya üst/alt vena kavada uzanan trombüs; pulmoner arterlerde embolik defekti de ara
• Damar konturunda düzensizlik, ekstravasküler hava/kontrast veya mediastinal-perikardiyal kan; perforasyon ve kanama olasılığını gösterir
• Kopmuş parçanın sağ kalpten pulmoner arter dallarına uzanması veya işlem yolu dışındaki beklenmedik vasküler yatakta sonlanması

Normalde

Normal santral kateter, giriş veninden vena kavaya uzanan kesintisiz tek bir hat izler; ucu beklenen kavoatriyal bileşkede sonlanır ve damar lümeni açıktır. Parça şüphesinde kateterin tüm torasik seyrini, proksimal uçtaki kopma düzeyini ve sağ kalp duvarından uzaklığını karşı taraf damarları ve önceki grafi/BT ile kıyasla.

Ayırıcı tanı

Bütünlüğü korunmuş santral venöz kateter

damar yolunu izler ve proksimal portla kesintisiz devam eder

Kontrastla çevrili akut trombüs

metal yoğunluklu değildir; lümen içinde dolum defekti şeklinde görünür

Pulmoner arter embolisi

damar akımına paralel metalik çizgi oluşturmaz; kontrastlı incelemede lümen içi dolum kusurudur

Tuzaklar

• Kateter parçası kalp hareketiyle kesitte çok kısa veya çift görünebilir; ardışık ince aksiyel kesit ve koronal/sagittal MPR'de tek doğrusal yapıyı izle.
• Görüntüye yalnız göğüs dahil edilmişse parça periferik venden veya alt vena kavadan girişli olabilir; BT kapsamı içindeki iki ucu belirle ve tüm vücut yolunu işlem bilgisiyle eşleştir.
• Tromboz eşlik etmeyebilir; parça saptandığında venöz lümeni ve pulmoner arter dallarını ayrı ayrı açıkça değerlendir.

Kendini dene

1. Port kateterin proksimal hattı kesiliyor; distal metal parça sağ ventrikül ve pulmoner arterde izleniyor. Tanı nedir?

   • Kateter fragmanı embolizasyonu
   • Pulmoner tromboemboli
   • Pacemaker elektrodu
   • Alt vena kava trombozu
   Cevabı göster

   Kateter fragmanı embolizasyonu. Proksimal süreklilik kaybı ve sağ kalp-pulmoner arter boyunca ilerleyen metalik parça kopmuş kateter fragmanını gösterir. BT'de damar içindeki lineer radyopak yabancı cisim kateter fragmanını düşündürür; yabancı cisim çevresinde trombüs gelişebileceğinden trombüs ayrıca değerlendirilmelidir.

2. Kateter parçasının serbest ucu sağ ventrikül dış sınırını aşıyor; komşu perikardda kan yoğunluğu var. Hangi komplikasyon önceliklidir?

   • Miyokard perforasyonu
   • Aseptik gevşeme
   • Vena kava filtresi eğilmesi
   • Venöz rekanalizasyon
   Cevabı göster

   Miyokard perforasyonu. Parça ucunun kalp duvarı dışına uzanması ve perikardiyal kan, miyokard perforasyonunu düşündürür. Serbest ucun kalp duvarı dışına uzanması ve perikardiyal kan yoğunluğu, literatürde bildirilen miyokard perforasyonu ve hemoperikard tablosunu doğrudan gösterir; diğer seçenekler bu akut yapısal hasarı açıklamaz.

İlgili konular

• Kateter perforasyonu ve kontrast ekstravazasyonu
• Kateter ilişkili venöz tromboz ve fibrin kılıfı

Kaynaklar

Bu sayfadaki 33 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 5 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez. İçerik yapay zekâ destekli bir süreçle güncel literatüre göre cümle cümle kaynaklarla karşılaştırıldı, ancak uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.