Periadrenal damar, lenf nodu ve retroperitoneal taklitçiler

Özet

Adrenal yatağın yakınından geçen damarlar, lenf nodları ve komşu organların çıkıntıları aksiyel BT'de adrenal kitle izlenimi verebilir. Sol tarafta splenik damarlar ve periadrenal kollateraller, sağda vena kava ve renal damar ilişkisi özellikle gözden geçirilmelidir. Damarı kitle sanıp biyopsi veya girişim planlamak kanama riski taşırken, lenf nodunu adrenal bez dokusu saymak evreleme ve karakterizasyonu yanlış yönlendirebilir.

Faz ve pencere

Portal tanısal

Adrenal komşuluğundaki damar veya kollateral, damar lümeniyle aynı kontrastlanma yoğunluğunda yuvarlak ya da tübüler odak olarak görünebilir; ardışık kesit ve multiplanar görüntülerde renal, splenik, frenik damar veya VCI ile devamlılık aranır.

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

BT bulguları

• Aksiyel kesitte oval ya da yuvarlak görünse de koronal/sagittal planda damar boyunca uzayan tübüler yapı
• Damar taklitçisinde kontrastlanma komşu renal damar, splenik damar, VCI veya kollateral damar lümeniyle eşleşir
• Sol adrenal bezin önünden geçen splenik damar veya splenorenal/gastrorenal kollateralin kitle benzeri enine kesiti
• Retroperitoneal lenfoma, adrenal yatağı genişleyen heterojen ve belirgin kontrastlanan kütle olarak izlenir; adrenal bez parankimiyle sınırları bulanıklaşabilir veya bez yerine geçebilir.
• Diyafram krusunun kalın veya oblik kesiti; koronal planda kas dokusuyla devamlılık gösterir
• Böbrek üst kutbu, pankreas kuyruğu veya dalak çıkıntısının adrenal yatağa doğru uzanması; kaynak organ konturunun devamlılığı

Normalde

Normal sağ adrenal bez V/ters Y biçiminde, karaciğerin medialinde ve VCI'nin arka-iç komşuluğunda; sol adrenal bez aortanın sol yanında, pankreas arkasında ve böbrek üst kutbunun ön-içinde izlenir. Şüpheli odağı, bezden çıkan iki kolun devamlılığı ve komşu damarların kontrastla dolan lümenleriyle kıyaslayın; kitle görünümü bu anatomik çizgilerden birine bağlanabiliyorsa adrenal parankim dışı kökeni düşünün.

Ayırıcı tanı

Adrenal adenom, benign adrenal lezyonlardan biri olabilir.

Paragangliom

adrenal dışında yerleşebilse de solid kitle olarak kalır; belirgin damar beslenmesi olabilir ancak renal/splenik damar lümenine anatomik devamlılığı yoktur.

Aksesuar dalak

dalakla aynı iç yapı ve fazlara göre benzer kontrastlanma örüntüsü gösterir; sol üst kadrandaki yerleşim ve dalakla doku benzerliği adrenal dışı kökeni destekler.

Renal üst kutup veya pankreas kuyruğu kitlesi

koronal/sagittal düzlemde böbrek korteksi ya da pankreas parankimiyle devamlılığı, adrenal köken yerine komşu organı gösterir.

Tuzaklar

• Tek aksiyel kesitte damar kesitini solid adrenal nodül olarak adlandırmayın; kontrastlı seride kraniokaudal devamlılığı koronal veya sagittal MPR'de izleyin.
• Periadrenal kollaterali kitle sanıp biyopsi hedefi olarak işaretlemeyin; portal hipertansiyon, splenorenal/gastrorenal şant ve komşu venöz bağlantıları araştırın.
• Lenf nodunun adrenal beze bitişik olmasını bez içi nodül kanıtı saymayın; yağ planını ve adrenal kolların ayrı izlenip izlenmediğini gösterin.
• Sol üst kadranda aksesuar dalak veya lobüle dalak konturunu adrenal tümörle karıştırmayın; dalakla benzer kontrastlanma ve anatomik devamlılık karşılaştırması yapın.

Kendini dene

1. Sol adrenal yatağın önündeki yuvarlak odak portal fazda splenik venle aynı kontrastlanıyor ve koronal planda venle birleşiyor. Bu yapı nedir?

   • Periadrenal varis
   • Adrenal adenom
   • Paraaortik lenf nodu
   • Adrenal kist
   Cevabı göster

   Periadrenal varis. Venle aynı kontrastlanma ve koronal planda lümen devamlılığı periadrenal kollateral/varisi gösterir. Adenom ve lenf nodu solid doku olarak damardan ayrı kalır; kist kontrastla damar gibi dolmaz.

2. Adrenal bezden ayrı, aorta ile sol renal ven arasında oval yumuşak doku odağı görülüyor; damar lümeniyle devamlı değil. En olası yapı nedir?

   • Paraaortik lenf nodu
   • Splenik arter
   • Adrenal kol
   • Diyafram krusu
   Cevabı göster

   Paraaortik lenf nodu. Sol adrenal bez sol böbrek üst kutbunun anteromedialinde, diyafram krusunun lateralinde ve pankreasın arkasında yer alır. Sol adrenal bez sol böbrek üst kutbunun anteromedialinde, diyafram krusunun lateralinde ve pankreasın arkasında yer alır.

Kaynaklar

Bu sayfadaki 33 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 5 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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