Mezenterik lenfadenit

Özet

Mezenterik lenfadenit, en sık çocuk ve gençlerde sağ alt kadran ağrısıyla apandisiti taklit eden reaktif lenf nodu inflamasyonudur. Portal venöz kontrastlı BT'de tanı yaklaşımı, kümelenmiş sağ alt kadran nodlarını gösterirken apendiksin tüm seyri boyunca normal olduğunu ve ileoçekal bölgede alternatif inflamasyon bulunup bulunmadığını doğrulamaya dayanır. Nod büyümesi tek başına özgül olmadığından apandisit, terminal ileit ve enfeksiyöz/iltihabi diğer nedenler görüntü üzerinde dışlanmalıdır. Apendiksin normal olduğunun gösterilmesi, mezenterik adenit değerlendirmesinde apandisiti dışlamaya yardımcı olur.

Faz ve pencere

Portal tanısal

Görüntülemede ağrı bölgesindeki mezenterik lenf nodları değerlendirilir; apandisit gibi cerrahi nedenlerin dışlanması için apendiks de incelenir. Terminal ileum ve çekum duvarı eşlik eden inflamasyon ya da alternatif neden açısından incelenir.

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

BT bulguları

• Mezenterik adenitte, ağrının bildirildiği bölgede mezenterik lenf nodları görüntülemede saptanabilir.
• Lenf nodlarının sayısı ile uzun ve kısa eksen ölçümleri görüntülemede kaydedilebilir.
• Mezasterik lenfadenit tanısı koyarken, apendikste apandisiti destekleyen bulguların olmaması ve cerrahi nedenlerin dışlanması şarttır.
• Apendiksin normal olduğunun değerlendirilmesi, apandisit gibi cerrahi nedenleri dışlama yaklaşımının parçasıdır.
• Terminal ileum/çekum duvar kalınlaşması veya bağırsak hiperemisi, ileit ya da enterokolit gibi eşlik eden bağırsak inflamasyonunu düşündürebilir.
• Peritoneal inflamasyon düşündüren bulgular görüldüğünde, peritonit gibi peritoneal aciller ayırıcı tanıda değerlendirilmelidir.

Ölçütler ve sınıflamalar

Klasik BT paterni (klinik bağlamla birlikte yorumlanır)

Ağrı bölgesinde mezenterik lenf nodlarının görülmesi, cerrahi nedenler dışlandıktan sonra mezenterik adenit değerlendirmesine katkı sağlar.

Normalde

Lenf nodu boyutu tek başına mezenterik adenit tanısını koydurmaz; benzer boyutlardaki nodlar asemptomatik çocuklarda da görülebilir. Görüntülemede apendiksin normal olup olmadığı ile lenf nodlarının sayısı ve kısa/uzun eksen ölçümleri birlikte değerlendirilir.

Ayırıcı tanı

Akut apandisit

apendiks genişlemesi, kalınlaşmış boyanan duvar ve apendiks merkezli çevre yağ infiltrasyonu tanıyı destekler.

Terminal ileit/Crohn hastalığı

terminal ileumda segmental duvar kalınlaşması, hiperemi, yağlı proliferasyon veya skip alanlar eşlik edebilir.

İleoçekal tüberküloz

çekum ve terminal ileum tutulumu, nekrotik lenf nodları ve peritoneal bulgularla birlikte olabilir.

Lenfoma

akut apandisit veya mezasterik lenfadenit ile benzer klinik ve görüntüleme bulguları verebilir; ayırıcı tanı için patolojik korrelasyon gereklidir.

Yersinia/diğer enfeksiyöz ileokolit

terminal ileum/çekum duvar inflamasyonu ve reaktif nodlar birlikte görülebilir; görüntüleme etkeni tek başına belirlemez.

Tuzaklar

• Apendiksin normal olduğunun gösterilmesi, cerrahi nedenleri dışlama değerlendirmesinin bir parçasıdır.
• Lenf nodu boyutu, apandisit ile ilişkili mezenterik adeniti cerrahi dışı nedenlere bağlı adenitten ayırt etmeyebilir; nodlar apendiks değerlendirmesinin yerine geçmez.
• Büyümüş mezasterik lenf düğümleri için literatürdeki eşik değerler (>4-20 mm) asemptomatik çocuklarda da görülebilir; bu nedenle düğüm boyutu başlı başına tanı koydurmaz.
• Lenf nodlarının sayısı ve boyutları görüntüleme incelemesinde kaydedilir.

Kendini dene

1. POCUS’ta mezenterik adenit düşünülebilmesi için önce hangi koşul sağlanmalıdır?

   • Karın ağrısının cerrahi nedenleri dışlanmalıdır
   • Lenf nodlarının kısa ekseni 10 mm’den büyük olmalıdır
   • Periappendiküler sıvı gösterilmelidir
   • Lenf nodlarında biyopsi yapılmalıdır
   Cevabı göster

   Karın ağrısının cerrahi nedenleri dışlanmalıdır. Mezenterik adenit tanısı düşünülmeden önce karın ağrısının cerrahi nedenleri dışlanmalıdır.

2. S2 çalışmasında mezenterik adenitli çocuklarda en sık bildirilen olası etiyoloji grubu hangisidir?

   • Olası viral hastalık
   • Primer idiopatik mezenterik adenit
   • Ekstrapulmoner tüberküloz
   • Piyelonefrit
   Cevabı göster

   Olası viral hastalık. S2 tablosunda olası viral hastalık 33 hastanın 16’sında (%48,5), primer mezenterik adenit 12’sinde (%36,4), ekstrapulmoner tüberküloz 2’sinde (%6,1) ve piyelonefrit 1’inde (%3) bildirilmiştir.

İlgili konular

• Mezenterik pannikülit

Kaynaklar

Bu sayfadaki 33 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 21 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.