Splenik ven trombozu ve sol taraflı portal hipertansiyon

Özet

Splenik ven trombozu pankreatit, pankreas psödokisti veya pankreas tümörüyle ilişkili olabilir ve dalağın venöz çıkışını engeller. Portal faz kontrastlı BT ven içi dolum defektini ya da kronik oklüzyonu, ayrıca gastrik fundus kollaterallerini ve altta yatan pankreas hastalığını gösterir. İzole splenik ven tıkanıklığı, karaciğer sirozu olmadan sol taraflı portal venöz hipertansiyon ve fundal varislere yol açabilir. Kollateral damarların veya trombozun fark edilmemesi, fundal varislerle ilişkili gastrointestinal kanama riskinin ve splenik venöz çıkış obstrüksiyonunun gözden kaçmasına yol açabilir.

Faz ve pencere

Portal tanısal

Kontrastla dolu splenik ven içinde santral veya eksantrik kontrastlanmayan dolum defekti akut/parsiyel trombüsü gösterir; kronik oklüzyonda ven izlenmeyebilir ve hilus çevresinde kıvrımlı perigastrik kollateraller belirginleşir.

Kontrastsız

Akut splenik ven trombozunun tanısında kontrastlı BT belirleyicidir; ven içinde kontrastlanmayan dolum defekti ve peripancreatik inflamasyon bulguları eşlik eder.

BT bulguları

• Splenik venin pankreas arkasındaki seyri boyunca kontrastlanmayan parsiyel veya tam lüminal dolum defekti.
• Pankreatit ile ilişkili splenik ven trombozu, akut pankreatitte pankreas çevresinde sıvı ve yağlı doku değişiklikleriyle birlikte görülebilir.
• Kronik tıkanmada ana splenik ven incelmiş, kesintili veya seçilemez; splenik hilus ve mide fundusu çevresinde venöz kollateraller gelişir.
• Kısa gastrik ve posterior gastrik venler fundal submukozal varislerle bağlantı kurar; gastroepiploik kollateraller büyük kurvatura boyunca uzanabilir.
• İzole sol taraflı portal hipertansiyonda karaciğer morfolojisi ve ana portal ven normal kalabilir; özofagus varisleri her zaman eşlik etmez.
• Pankreas gövde-kuyruk inflamasyonu, nekroz, psödokist veya kitle splenik ven basısı/trombozunun nedenini gösterebilir.
• Dalak konjesyonu ve splenomegali sık görülür; akut veya kronik pankreatit vakalarında üstmezenterik ve ana portal ven dahil diğer splanknik venlerin tutulumu da değerlendirilmelidir.

Normalde

Normal splenik ven pankreas arkasında düzgün biçimde kontrastlanır ve portal venöz birleşkeye kesintisiz ulaşır; içinde dolum defekti veya hilus çevresinde belirgin genişlemiş gastrik kollateraller yoktur. Aynı aksiyel ve koronal düzlemlerde ven lümeninin sürekliliğini, portal ven açıklığını ve karaciğer konturunu kıyaslayarak izole sol taraflı obstrüksiyonu yaygın portal hipertansiyondan ayır.

Ayırıcı tanı

Pankreas tümörüne bağlı venöz invazyon

damar duvarı düzensizliği, lümen içinde tümör dokusu veya eşlik eden kitle bulunabilir.

Portal ven trombozu

dolum defekti ana portal ven içindedir ve yaygın kollateral/karaciğer değişiklikleri eşlik edebilir.

Siroza bağlı genel portal hipertansiyon

nodüler karaciğer konturu, portal sistemde daha yaygın kollateraller ve özofagus varisleri lehinedir.

Sirotik portal hipertansiyon

Karaciğerde nodüler kontur, genişlemiş ana portal ven ve özofagus/gastroesofajean varisler gibi yaygın portal sistem tutulumu lehinedir.

Pankreas kitlesiyle birlikte splenik ven trombozu görüldüğünde tümöral trombüs olasılığı da göz önünde bulundurulmalıdır.

Tuzaklar

• İzole sol taraflı portal hipertansiyon ile sirotik portal hipertansiyonu karıştırmamak gerekir; karaciğer morfolojisinin normal olması ve portal venin açık kalması izolasyonu doğrular.
• Kronik oklüzyonda ven hiç seçilemeyebilir; yalnız doğrudan lümene bakma, hilus çevresi ve mide fundusundaki kollateralleri tara.
• Pankreatit çevresinde dalak hilusu ve mide çevresindeki kollateralleri değerlendir; BT'de bunlar kıvrımlı ve genişlemiş damarlar olarak görülebilir.
• İzole splenik ven tıkanıklığını siroza bağlı genel portal hipertansiyonla eşitleme; karaciğer morfolojisini ve ana portal ven açıklığını ayrı değerlendir.
• Splenik vende dolum defekti şüphesinde BT incelemesi uygun protokolle yapılmalıdır; visseral ven trombozlarının tanısında doğru protokol önem taşır.

Kendini dene

1. Pankreatitli hastada splenik ven kontrastlanmıyor; dalak hilusunda ve mide fundusunda kıvrımlı damarlar var, karaciğer normal. En olası durum?

   • İzole splenik ven trombozu
   • Sirotik portal hipertansiyon
   • Ana portal ven anevrizması
   • Splenik arter psödoanevrizması
   Cevabı göster

   İzole splenik ven trombozu. Pankreatik hastalık, splenik ven oklüzyonu ve fundal kollateraller izole sol taraflı portal venöz hipertansiyon örüntüsüdür. Sirozda karaciğer konturu ve kollateraller daha yaygın etkilenebilir; arter psödoanevrizması arteriyel kontrastlanan kese olur.

2. Splenik ven oklüzyonu, fundal varisler, açık ana portal ven ve siroz bulgusu olmayan karaciğer hangi örüntüyü destekler?

   • İzole sol taraflı (sinistral) portal hipertansiyon
   • Sirotik portal hipertansiyon
   • Budd–Chiari sendromu
   • Arteriyoportal fistül
   Cevabı göster

   İzole sol taraflı (sinistral) portal hipertansiyon. Splenik ven çıkış obstrüksiyonu gastrosplenik bölgede venöz basıncı artırıp kollateral dolaşım oluşturabilir. Korunmuş karaciğer işlevi ve normal portal ven basıncı sinistral portal hipertansiyonla uyumludur.

İlgili konular

• Splenik arter anevrizması ve psödoanevrizması
• Gamna–Gandy cisimcikleri

Kaynaklar

Bu sayfadaki 37 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 8 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.