İnfeksiyöz kolit

Özet

Enfeksiyöz kolit, bakteriyel, viral veya paraziter etkenlerin kolon mukozasında oluşturduğu akut inflamasyondur ve bulguları klinik ile radyolojik olarak diğer akut kolit tipleriyle örtüşebilir. BT genellikle karın ağrısının nedenini araştırırken kolon tutulumunun dağılımını ve ağırlaşma bulgularını gösterir; tek başına etkeni kanıtlamaz. Sürekli ya da yaygın tutulum ve ödemli duvar enfeksiyonu düşündürebilir, ancak iskemi ve inflamatuvar bağırsak hastalığı da benzer görünür. Enfeksiyöz kolitte BT bulguları sıklıkla nonspesifiktir ve diğer kolit tipleriyle örtüşebilir; bu nedenle kesin tanı ve tedavi için klinik değerlendirme ve laboratuvar sonuçlarının tamamlayıcısıdır.

Faz ve pencere

Portal tanısal

Kolon duvarında mukozal hiperemi, submukozal ödem ve serozal yüzeyde inflamasyon; perikolik yağ değişiklikleri ve serbest sıvı değerlendirilir. Damar kaynaklı iskemi şüphesinde portal faz tek başına yeterli olmayabilir.

Önerilen pencereler: Batın (G 400 / M 50), Akciğer (G 1500 / M -600).

BT bulguları

• Tek bir segmentte veya kesintisiz biçimde birden çok kolon segmentinde çevresel duvar kalınlaşması
• Mukozal kontrast artışı ile hipoatenüasyonlu submukozal ödemin oluşturduğu hedef/çift halo görünümü
• Enfeksiyon belirtisi olarak boş kolon işareti (kolon lümeninde gaz, sıvı veya dışkı yokluğu), bakteriyel kolitte hastaların yaklaşık yarısında sıklıkla izlenir.
• Perikolik yağda hafif çizgilenme ve serozal yüzey boyunca inflamasyon; şiddeti etken ve evreye göre değişir
• Kalınlaşmış haustral kıvrımlar arasına oral kontrastın sıkıştığı akordeon görünümü, özellikle psödomembranöz kolitte görülebilir
• Reaktif bölgesel lenf düğümleri veya az miktarda serbest peritoneal sıvı
• Belirgin kolon dilatasyonu, ekstraluminal hava veya intestinal pneumatosis ciddi hastalık veya nekroz belirtisidir.

Normalde

Normal kolon, çekumdan rektuma kadar düzenli seyirli ve içeriğine göre değişen kalibrasyonda izlenir; duvarı ince, kontrastlanması homojen ve haustral kıvrımları korunmuştur. Kıyaslarken etkilenen segmentin uzunluğunu, duvar katmanlarını ve çevresindeki yağ dokusunu komşu etkilenmemiş kolonla karşılaştır; tek başına duvar kalınlaşması etkeni belirlemez.

Ayırıcı tanı

İskemik kolit

splenik fleksura veya rektosigmoid sınır bölgelerinde segmental tutulum ve azalmış duvar kontrastlanması damar kaynaklı hasarı düşündürür.

Ülseratif kolit

rektumdan proksimale kesintisiz yayılım ve kronikleşmede haustral kayıp ile kolon kısalması ayırıcı ipuçlarıdır.

Crohn hastalığı

atlamalı segmentler (skip areas), terminal ileum tutulumu, striktür ve penetran hastalık bulguları ( fistül, apseler) beklenebilir.

Psödomembranöz kolit

orantısız belirgin duvar kalınlaşması, katmanlı ödem ve bazen akordeon görünümü bu alt tipi akla getirir.

Tuzaklar

• Hedef işareti enfeksiyona özgü değildir; inflamatuvar ve iskemik kolitler de aynı katmanlı duvar görünümünü oluşturabilir.
• Perikolik yağ çizgilenmesinin hafif olması enfeksiyonu dışlamaz; bu bulgunun derecesi etkeni sınıflandırmak için tek başına güvenilir değildir.
• Akordeon görünümü Clostridioides difficile için düşündürücü olsa da tek başına özgül değildir; ilaç öyküsü ve laboratuvar doğrulaması gerekir.

Kendini dene

1. Sulu ishalli hastada BT'de kesintisiz kolon duvarı kalınlaşması, mukozal kontrastlanma ve submukozal ödem görülebilir. BT en çok neyi destekler?

   • Akut enfeksiyöz kolit
   • Kolon adenokarsinomu
   • Sigmoid volvulus
   • Divertiküler apse
   Cevabı göster

   Akut enfeksiyöz kolit. Uzun segmentli katmanlı inflamasyon akut kolitle uyumludur; klinik ve dışkı testleri olmadan etken belirlenemez. Adenokarsinom daha çok fokal/asimetrik kitle oluşturur; volvulusta burulma ve kapalı ans, apsede ise fokal koleksiyon aranır.

2. Kolon duvarındaki ödemli kıvrımların arasına oral kontrast şeritler halinde doluyor. Bu görünüm en çok hangi tanıyla ilişkilidir?

   • Psödomembranöz kolit
   • İskemik proktit
   • Crohn striktürü
   • Kolon lipomatozisi
   Cevabı göster

   Psödomembranöz kolit. Ödemli haustralar arasında kontrastın sıkışması akordeon görünümüdür ve psödomembranöz kolitte görülebilir. Bu bulgu tek başına kesin tanı değildir; diğer seçenekler bu kıvrım-kontrast örüntüsünü tipik olarak oluşturmaz.

Kaynaklar

Bu sayfadaki 35 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 7 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.