Hemorajik kolesistit

Özet

Hemorajik kolesistit, çoğunlukla akut kolesistit zemininde safra kesesi duvarındaki damarların erozyonuyla lümene kanama gelişmesidir; antikoagülasyon, travma ve girişimler olasılığı artırabilir. Kontrastsız BT pıhtı veya kanla dolu lümeni gösterirken kontrastlı inceleme aktif kanamayı ve yayılımı araştırır. Hemobili, hemoperitoneum ve kese perforasyonu klinik kötüleşmenin nedenleri olabilir. Kan ürünleri yoğun safra çamuru veya kontrast atılımı sanılırsa kanama kaynağı gözden kaçabilir.

Faz ve pencere

Kontrastsız tanısal

Safra kesesi lümeninde safra içeriğine göre hiperatenuasyonlu, tabakalaşabilen veya sıvı-sıvı seviyesi oluşturan kan/pıhtı görülebilir; lümen içi taşlar ve duvar kalınlığı da seçilir.

Arteriyel tanısal

Kontrastlı BT’de kistik arterden safra kesesine kontrast ekstravazasyonu aktif kanamayı gösterebilir; kistik arter psödoanevrizması da saptanabilir.

Portal

Perikolesistik inflamasyon, karaciğer yatağına uzanım, hemoperitoneum ve eşlik eden hemobili/kan ürünlerinin safra yollarına ilerlemesi değerlendirilir; arteriyel odak bu fazda daha az belirgin olabilir.

BT bulguları

• Safra kesesi lümeninde hiperdens kan veya şekilsiz pıhtı; kontrastsız seride belirginleşir.
• Lümen içindeki kanın tabakalanması veya katmanlaşmış hiperdens materyal.
• Distansiyonla birlikte diffüz veya düzensiz duvar kalınlaşması ve duvar ödemi.
• Kese çevresi yağ dokusunda kirlenme, sıvı ve karaciğer yatağında inflamatuvar değişiklik.
• Arteriyel fazda kese duvarı boyunca aktif kontrast ekstravazasyonu veya kistik arter psödoanevrizması.
• Koledok ya da intrahepatik kanallarda hiperdens materyal hemobili ve pıhtı geçişini düşündürür.
• Kese dışı yüksek atenüasyonlu sıvı hemoperitoneum; duvar kesintisi ve çevre koleksiyon perforasyonu düşündürür.

Normalde

Lümen içinde katmanlaşan hiperdens materyal kan veya pıhtı şüphesi doğurur, ancak çamur ve vikariyöz kontrast atılımıyla karşılaştırılmalıdır.

Ayırıcı tanı

Yoğun safra çamuru

kontrastsız seride hiperdens görünebilir; hareketliliği, akustik gölge yokluğu ve klinik bağlam ile ayrılır.

Vikaryöz kontrast atılımı

yakın zamanda iyotlu kontrast verilmişse safra kesesi yoğunlaşabilir; kontrastsız başlangıç BT'siyle ayır.

Safra kesesi tümörü

fokal/nodüler duvar kitlesi ve kalıcı kontrastlanma kan pıhtısından daha şüphelidir.

Akalkülöz akut kolesistit

duvar ödemi ve çevre inflamasyon yapabilir; lümende kan/pıhtı olmaması hemorajik bileşeni desteklemez.

Kolesistoenterik fistülde BT’de safra kesesi ile komşu bağırsak arasında fistül traktı ve safra kesesi lümeninde hava görülebilir.

Tuzaklar

• Yakın tarihli kontrastlı BT sonrasında safra kesesinde iyot atılımı hiperdens kanı taklit eder; önceki incelemenin zamanı ve kontrastsız serideki yoğunluğu sorgula.
• Kontrastlı BT'de aktif intralüminal kontrast ekstravazasyonu ve kistik arter psödoanevrizması hemorajik kolesistitte görülebilen bulgulardır.
• Safra kesesi içindeki hematom BT’de safra kesesi karsinomu veya invaziv hilar kolanjiyokarsinomla karışabilir.
• Arteriyel ekstravazasyon görülmemesi kanamayı dışlamaz; kanama aralıklı olabilir veya pıhtıyla tamponlanabilir.

Kendini dene

1. Kontrastsız BT’de distandü safra kesesi içinde hiperdens materyal görülmesi hangi tanıyı destekler?

   • Hemorajik kolesistit
   • Safra kesesi adenokarsinomu
   • Kolesistoenterik fistül
   • Safra kesesi torsiyonu
   Cevabı göster

   Hemorajik kolesistit. Hemorajik kolesistitte kontrastsız BT’de safra kesesi içinde hiperdens sıvı veya kan ürünü görülebilir.

2. Kontrastlı BT’de kistik arterden safra kesesine kontrast ekstravazasyonu görülüyor. Bu görünüm en çok neyi gösterir?

   • Aktif kanama
   • Safra çamuru
   • Duvar kalsifikasyonu
   • Koledok taşı
   Cevabı göster

   Aktif kanama. Kistik arterden safra kesesine kontrast ekstravazasyonu aktif kanamayla uyumludur. Kontrastlı BT’de kistik arter psödoanevrizması da saptanabilir.

İlgili konular

• Akut kalküloz kolesistit
• Hemobili

Kaynaklar

Bu sayfadaki 35 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 14 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.