Dalak metastazları

Özet

Dalak metastazları, genellikle yaygın malignitesi bulunan hastada gelişen ve izole görüldüğünde daha seyrek olan sekonder lezyonlardır. BT'de tek veya çoklu solid/kistik düşük atenüasyonlu odaklar şeklinde görülür ve portal venöz fazda sıklıkla daha iyi seçilir. Lezyonun karakterizasyonu, primer tümörün histolojik yapısı, eşlik eden başka metastazlar ve lezyon içi nekroz veya kalsifikasyon gibi morfolojik detaylara göre şekillenir. Hipodens splenik lezyonlar klinik bağlamla değerlendirilmelidir; çoğu benign bulunurken, onkolojik hastalarda yeni odaklar dikkat gerektirir, ancak her hipoatenüasyon metastaz anlamına gelmez.

Faz ve pencere

Kontrastsız

Lezyonlar kontrastsız BT'de hipodens veya değişken atenüasyonda olabilir; melanom metastazları kaynaklara göre kontrastsız görüntüde hipodens olarak rapor edilmiştir.

Portal tanısal

Metastazlar çoğunlukla dalak parankimine göre düşük atenüasyonlu, iyi sınırlı veya silik solid/kistik odaklar olarak belirir; nekroz ve periferik/septal kontrastlanma görülebilir.

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

BT bulguları

• Tek veya çoklu solid/kistik fokal splenik lezyon.
• Portal fazda normal dalak parankimine göre hipoatenüasyon.
• Lezyon sınırları iyi seçilebilir veya infiltratif/silik olabilir.
• Nekrotik lezyonlarda santral sıvı atenüasyonu ve periferik kontrastlanma.
• Müsinöz primer tümörlerde kistik görünüm veya kalsifikasyon gelişebilir.
• Eşlik eden karaciğer, akciğer, kemik veya peritoneal metastazlar tanısal bağlam sağlar.
• Peritoneal implantlar dalak yüzeyinde dıştan bası ve çentiklenme oluşturabilir; bu bulgu intraparenkimal metastazdan ayrılmalıdır.

Normalde

Normal dalak kontrastlı portal fazda homojen ve çevre yumuşak dokudan belirgin şekilde kontrastlanan parankimdir; fokal hipoatenüasyon, nekrotik merkez ya da dış konturda implant kaynaklı çentiklenme bulunmaz. Bilateral üst batın kesitlerinde dalak odaklarını karaciğer ve periton lezyonlarıyla aynı fazda karşılaştırıp intraparenkimal yerleşimi kapsül yüzeyindeki implantlardan ayırın.

Ayırıcı tanı

Splenik lenfoma

diffüz büyüme, milier veya çoklu nodüler tutulum ve lenfadenopati eşlik edebilir.

Dalak apsesi

kontrastlı BT'de kalın, düzensiz kontrastlanan kenar ve enfeksiyon öyküsü tanıyı destekler.

Littoral hücre anjiyomu

yaygın nodüller yapabilir; fazlar arasında farklılaşan görünürlük ve uzamış dolum görülebilir.

Basit kist veya lenfanjiyom

kistik içerik kontrastlanmaz; lenfanjiyomda ince septalı multiloküle yapı bulunur.

Peritoneal implant

splenik kapsül dış yüzeyini çentikleyebilir, ancak parankim içinde merkezlenmiş değildir.

Tuzaklar

• Arteriyel fazda dalak fizyolojik olarak heterojen kontrastlanabilir; metastaz için portal fazda kalıcı fokal lezyon arayın.
• Melanom metastazları kaynaklara göre kontrastsız BT'de hipodens görünebilir; bu nedenle hipodens şablonunun dışında kalan bulgular için klinik bağlam gözden geçirilmelidir.
• Kapsül yüzeyindeki peritoneal implantı intraparenkimal metastaz sanmayın; dalak konturunda dıştan bası ve peritoneal yayılımı izleyin.
• Tek splenik odak her zaman metastaz değildir; splenik lenfoma da tek lezyon şeklinde görülebilir ve hipoatenüasyonlu odağın yorumunda klinik bağlam önemlidir.

Kendini dene

1. Akciğer kanseri olan hastanın portal faz BT'sinde dalak içinde yeni hipoatenüasyonlu nodül ve karaciğerde benzer odaklar var. En olası tanı?

   • Dalak metastazı
   • Splenik lenfoma
   • Littoral hücre anjiyomu
   • Lenfanjiyom
   Cevabı göster

   Dalak metastazı. Bilinen solid primer ve karaciğerde eşlik eden metastatik odaklar splenik metastazı destekler. Lenfoma sistemik lenf nodu/organ dağılımıyla; littoral anjiyom çoklu vasküler nodüllerle; lenfanjiyom kontrastlanmayan multiloküle kistlerle ayrılır.

2. Bilinen malignitesi olan hastada dalak yüzeyinde dıştan bası yapan nodül ve kapsüler çentiklenme var; parankim odağı yok. Hangi yerleşim daha olası?

   • Peritoneal implant
   • Splenik lenfoma
   • SANT
   • Dalak apsesi
   Cevabı göster

   Peritoneal implant. Kapsül dışından bası ve konturda çentiklenme peritoneal implant yerleşimini destekler. Lenfoma ve SANT parankim içinden kaynaklanır; apse için enfeksiyon bağlamı ve duvarlı koleksiyon beklenir.

İlgili konular

• Dalak lenfoma tutulumu

Kaynaklar

Bu sayfadaki 37 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 7 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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