Aksesuar veya duplike diyafram BT bulguları

Özet

Aksesuar diyafram, normal diyaframın üzerinde yer alan ve hemitoraksı iki kompartmana ayırabilen nadir, doğumsal bir fibromüsküler membrandır. Çoğu kez sağ tarafta görülür ve bronş ile pulmoner damarların geçtiği bir hiatus içerebilir. BT, aksesuar diyaframı ve hiatusundan anormal dağılım göstererek geçen pulmoner damarlar ile bronşları gösterebilir. Skimitar sendromu gibi bronkovasküler anomalilerle birlikteliği araştırılmalıdır.

Okuma sırası

aksesuar membran. Normal diyaframın üzerinde yer alan aksesuar membranı ve varsa merkezi hiatusunu ara.
membran ve duvar bağlantısı. Membranın fibromüsküler yapısını ve merkezi hiatusundan geçen pulmoner damarlar ile bronşları değerlendir.
normal ana diyafram. Aksesuar diyaframın normal diyaframın üzerinde konumlandığını doğrula.
ipsilateral akciğer lobları. BT'de aksesuar diyafram hiatusundan geçen bronş ve pulmoner damarların dağılımını incele; anormalse tarif et.
pulmoner damarlar ve plevra. BT kesitlerinde aksesuar diyaframı ve hiatusundan geçen bronş ile pulmoner damarların seyrini izle.

Faz ve pencere

Kontrastsız tanısal: BT'de aksesuar diyafram ve hiatusundan geçen pulmoner damarlar ile bronşların dağılımı gösterilebilir. BT'de aksesuar diyafram ve hiatusundan geçen bronş ile damarların dağılımı görülebilir.

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

AkciğerG 1500 / M −600
Yumuşak dokuG 400 / M +40

BT bulguları

Ana diyafram yaprağından ayrı, toraks içinde ince fibromüsküler membran izlenir.
Membran hemitoraksı iki kompartmana ayırabilir; merkezinde bronş ve pulmoner damarların geçtiği bir hiatus bulunabilir.
Aksesuar diyafram asemptomatik olgularda rastlantısal olarak saptanabilir.
Bronş ve damarların anormal dağılımı veya skimitar sendromu gibi bronkovasküler varyantlarla birlikte görülebilir.
BT, aksesuar diyafram hiatusundan anormal dağılım göstererek geçen pulmoner damarlar ve bronşları göstermeye yardımcı olur.

Normalde

Aksesuar diyafram, normal diyaframın üzerinde ek bir fibromüsküler membran olarak izlenir. Aksesuar diyaframın normal diyaframa göre konumu ile hiatusundan geçen bronş ve damarların dağılımı görüntülemede değerlendirilebilir.

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 s1278; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Aksesuar diyafram, bronş ve damarların geçtiği merkezi bir açıklığa sahip nadir bir konjenital intratorakal malformasyondur.
Bu anomali skimitar sendromuyla birlikte görülebilse de izole erişuar diyafram vakaları da bildirilmektedir.
Görüntülemede normal diyafram kubbesinin üzerinde ekstra bir fibromüsküler membran varlığı araştırılmalıdır.
Pulmoner damar ve bronşların aksesuar diyafram hiatusundan anormal dağılım gösterdiği durumlarda bu dağılım görüntülemede değerlendirilmelidir.
Aksesuar diyafram durumunda karın içeriğinin toraksa yer değiştirmesi yerine, fibromüsküler membranın toraks içinde iki kompartmanı ayırması beklenir.

Tuzaklar

Aksesuar diyaframın konumu ile hiatusundan geçen bronş ve damarların dağılımı BT'de değerlendirilmelidir.
Ek membran ile birlikte normal diyafram yapısının altta devam ettiği ve karın organlarının normal pozisyonda bulunduğu değerlendirilmelidir.
Hiatusundan geçen pulmoner damar ve bronşların dağılımı dikkatle incelenmelidir.
Membran üzerindeki veya yakınındaki pulmoner damarların anormal dağılımı değerlendirilmeli, şüphede çok düzlemli görüntülerle damar devamlılığı izlenmelidir.
Aksesuar diyafram membranını ve hiatusundan anormal dağılımla geçen pulmoner damarlar ile bronşları BT'de değerlendir.

Kendini dene

Normal diyaframın üzerinde yer alan, merkezi hiatusundan pulmoner damarlar ve bronşlar geçebilen nadir konjenital fibromüsküler anomali hangisidir?
Cevabı göster
Aksesuar hemidiyafram. Aksesuar hemidiyafram, normal diyaframın üzerinde yer alan fibromüsküler bir yapı olup genellikle pulmoner damarlar ile bronşların geçtiği merkezi bir hiatus içerir. Aksesuar hemidiyafram skimitar sendromuyla ilişkili olabilir; ancak izole olgular da bildirilmiştir.
Aksesuar hemidiyaframın merkezi hiatusundan hangi yapılar geçebilir?
Cevabı göster
Pulmoner damarlar ve bronşlar. Aksesuar hemidiyaframın merkezi hiatusundan pulmoner damarlar ve bronşlar geçebilir.

İlgili konular

Kaynaklar

Bu sayfadaki 34 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 27 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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