Pankreatit ilişkili arteriyel/venöz tromboz BT bulguları

Özet

Pankreas ödemi ve sıvı koleksiyonlarının çevre venlere yaptığı bası venöz staza katkıda bulunabilir; akut pankreatitte splanknik ven trombozu görülebilir ve en sık splenik ven etkilenir. Çok fazlı kontrastlı BT damar lümenini, trombüsün uzanımını ve organ perfüzyonuna etkisini aynı incelemede haritalar. Mezenterik arter oklüzyonu ile mezenterik venlere uzanan portal ven trombozunu ayırt etmek önemlidir; portal ven trombozunda portal hipertansiyon, mezenterik venler de tıkandığında bağırsak iskemisi gelişebilir. Portal ven trombozu mezenterik venlere uzanıp bu venleri tıkadığında bağırsak iskemisi gelişebilir.

Faz ve pencere

BTA tanısal: Pankreatit ilişkili psödoanevrizma BT anjiyografiyle gösterilebilir; splanknik venöz trombozun değerlendirilmesinde portal venöz fazlı kontrastlı BT etkilidir.
Portal tanısal: Portal venöz fazlı kontrastlı BT'de splanknik venöz sistemde kısmi veya tam dolum defekti aranır; trombüsün uzanımı bu incelemeyle değerlendirilebilir.

Önerilen pencereler G genişlik, M merkez; değerler Hounsfield birimi (HU)

AnjiyoG 600 / M +150
BatınG 400 / M +50

BT bulguları

Venöz tromboz görüntülemede splanknik venöz sistemde kısmi veya tam dolum defektiyle gösterilebilir.
Splenik, portal veya mezenterik vende kısmi ya da tam tromboz görülebilir.
Trombüsün pankreatik nekroz veya koleksiyonla doğrudan komşuluğu ve damar dıştan basısının eşlik edip etmediği
Karaciğerde kama biçimli veya coğrafi kontrastlanmayan lezyon, uygun klinik bağlamda vasküler-iskemik hasar olasılığını düşündürmelidir.
Portal ven trombozu mezenterik venlere uzanıp bu venleri tıkadığında bağırsak iskemisi gelişebilir.
Kronik portal ven trombozunda portal kavernom olarak adlandırılan hepatopetal kollateral ven ağı gelişebilir.
Karaciğerde kama biçimli veya coğrafi kontrastlanmayan lezyon, uygun klinik bağlamda vasküler-iskemik hasarı düşündürebilir.
Nekrotizan pankreatitte arteriyel fazda splenik hilustaki bir lezyon psödoanevrizma izlenimi verebilir; ayırıcı değerlendirmede lezyonun fazlardaki görünümü dikkate alınmalıdır.
Pankreatit, splenik arter psödoanevrizmasıyla ilişkili olabilir; psödoanevrizmalar BT anjiyografiyle gösterilebilir.

Normalde

Portal ven, splenik ven ile superior mezenterik venin birleşmesiyle oluşur. Splanknik venöz tromboz açısından venöz sistemde kısmi veya tam dolum defekti aranır.

Normal BT ile kıyasla

Aynı bölgenin, kaynak veri setinde patoloji içermediği belirtilen bir BT incelemesini kesit kesit kaydırın; organ sınırlarını açarak anatomiyi hasta görüntüsüyle karşılaştırın. Küçük rastlantısal bulgular tümüyle dışlanmamıştır.

Kaynak: TotalSegmentator v2.01 veri seti (Wasserthal ve ark., Radiology: Artificial Intelligence 2023), CC BY 4.0, vaka s0541; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Dıştan bası pankreatitte çevre venlerde staz oluşturabilir; splanknik ven trombozu görüntülemede kısmi veya tam dolum defektiyle gösterilir.
Portal venöz fazda kontrastlı BT, splanknik venöz trombozu değerlendirmede etkilidir; tanıda venöz sistemde parsiyel veya tam dolum defekti aranır.
Portal ven trombozunun ayırıcı tanısında malign portal ven invazyonu ve özellikle pankreatik kanserin oluşturabileceği damar basısı da dikkate alınmalıdır.
Portal kavernomu, kronik portal ven trombozunda gelişebilen hepatopetal kollateral ven ağıdır; akut tromboz ani ortaya çıkar.
Pankreas ödemi ve sıvı koleksiyonları çevre venlerde bası ve staza yol açabilir; splanknik ven trombozu tanısı görüntülemede kısmi veya tam dolum defekti gösterilmesine dayanır.

Tuzaklar

Splanknik venöz tromboz şüphesinde kontrastlı BT portal venöz fazda değerlendirilir; tanıda venöz sistemde parsiyel veya tam dolum defekti aranır.
Pankreas ödemi ve sıvı koleksiyonlarının çevre venlere basısı venöz staza katkıda bulunabilir; splanknik ven trombozu görüntülemede kısmi veya tam dolum defektiyle gösterilir.
Karaciğerde kama biçimli veya coğrafi kontrastlanmayan lezyon, uygun klinik bağlamda vasküler-iskemik hasar olasılığını düşündürmelidir.

Kendini dene

Nekrotizan akut pankreatitli bir hastanın kontrastlı BT'sinde superior mezenterik vende kısmi dolum defekti görülüyor. En olası açıklama hangisidir?
Cevabı göster
SMV trombozu. Superior mezenterik vendeki kısmi dolum defekti, bu vende kısmi trombozla uyumludur; akut nekrotizan pankreatitte bu bulgu bildirilmiştir.
Görüntülemede splanknik ven trombozunu en doğrudan destekleyen bulgu hangisidir?
Cevabı göster
Ven lümeninde kontrastla çevrili dolum kusuru. Splanknik ven trombozu görüntülemede venöz sistemdeki kısmi veya tam dolum defektiyle tanınabilir.

İlgili konular

Kaynaklar

Bu sayfadaki 35 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 28 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.