Obstrüktif (rezorptif) atelektazi BT bulguları

Özet

Bir bronş mukus, yabancı cisim, endobronşiyal tümör veya dıştan bası nedeniyle tıkandığında distal alveollerdeki hava emilir ve ilgili akciğer bölümü çöker. BT, bronş lümenindeki obstrüksiyonu ve distalindeki atelektatik değişiklikleri gösterebilir. Erişkinde kalıcı segmental veya lobar kollaps, özellikle sağ orta lob sendromunda, altta yatan maligniteyle ilişkili olabilir; bulguyu yalnız mukus tıkacına bağlamak tümörün gözden kaçmasına yol açabilir. Hava yolu açıklığı, distal parankim ve komşu loblardaki kompansatuvar genişleme birlikte değerlendirilmelidir.

Faz ve pencere

Kontrastsız tanısal: Tıkanan lob bronşunun distalinde atelektazi görülebilir; BT’de bronş lümenindeki obstrüksiyon ve distal atelektatik değişiklikler gösterilebilir. Kollabe akciğer hacim kaybı ve aynı tarafa mediastinal yer değiştirme ile görülebilir.

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

AkciğerG 1500 / M −600
MediastenG 350 / M +50

BT bulguları

Distal kollaps — atelektazi, akciğer dokusunun çökmesine bağlı hacim kaybı olarak tanımlanır.
Hava yolu tıkanıklığı — endobronşiyal lipom gibi bir lezyon lob bronşunu tıkayarak distal atelektaziye yol açabilir.
Hava bronkogramı — atelektazide hava bronkogramları görülebilir; bu bulgu tek başına pnömoniyi göstermez.
Kompansatuvar aşırı havalanma — sağ orta lob atelektazisi arttıkça sağ alt lob hacminin artması kompansatuvar aşırı havalanmayı düşündürebilir; atelektaziye aynı tarafta mediastinal yer değiştirme eşlik edebilir.
Obstrüktif nedenin karakteri — rezorptif atelektazi, tümör, yabancı cisim veya hareketli bir mukus tıkacı gibi merkezi bir obstrüksiyona bağlı olarak gelişir.

Ölçütler ve sınıflamalar

Obstrüktif (rezorptif) atelektazi: Santral hava yolu tıkanıklığı, özellikle tümöre ve daha seyrek olarak yabancı cisme bağlı olduğunda, distal havanın rezorpsiyonuyla rezorptif atelektaziye yol açabilir.

Normalde

Kollaps düşünülen alanda BT ile bronş lümenini inceleyin; bronş obstrüksiyonu ve distal atelektatik değişiklikler görülebilir.

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

Pnömonik konsolidasyon: pnömoni ve atelektazi her ikisi de plevra tabanlı opasite ve hava bronkogramı gösterebilir; statik hava bronkogramları küçük hava yolu atelektazisinde daha sık iken pnömoneidede de görülebilir.
Kompresif atelektazi: dıştan bası, lobar atelektazinin mekanik nedenlerinden biri olabilir.
Pulmoner infarkt: atelektazi ve pnömoni dışında, hemoraji ve pulmoner infarkt gibi durumlar da plevra tabanlı konsolidasyon ve hava bronkogramı oluşturabilir.
Endobronşiyal tümör: merkezi hava yolu obstrüksiyonuna yol açarak rezorptif atelektaziye neden olabilir.
Yuvarlak atelektazi: kronik veya tekrarlayan plevral efüzyonla ilişkili subplevral kitle benzeri kollaps ve plevral kalınlaşma görülebilir; bronş ve damarların lezyona kıvrılarak yaklaşması “comet-tail” bulgusudur.

Tuzaklar

Erişkinlerde, özellikle sağ orta lob atelektazisinde malignite olasılığı göz önünde bulundurulmalıdır; bir seride sağ orta lob sendromu olgularının yaklaşık dörtte birinde malignite saptanmış ve her sağ orta lob atelektazisinde bronkoskopi önerilmiştir.
Yuvarlak atelektazi — plevraya komşu kitle benzeri görünüm ve lezyona giren kıvrımlı çizgilerle oluşan “kuyruklu yıldız” bulgusu görülebilir.
Obstrüktif atelektazide hava bronkogramı görülebilir; hava bronkogramlarının varlığı tek başına pnömoniyi kanıtlamaz.
Lob kollapsında hilus siluetinde azalma, hemidiyafram yüksekliği ve mediastinal yer değiştirme görülebilir; sol alt lob kollapsında lobun omurga boyunca retraksiyonu BT’de izlenebilir.
Obstrüktif atelektazide hilusta nodül veya neoplastik infiltrasyon görülebilir; BT bronş lümenindeki tıkanıklığı gösterebilir. Obstrüktif atelektazi örneğinde hilusta nodül görülebilir; bu nedenle kollaps değerlendirilirken bronş lümeni ve hilus incelenmelidir.

Kendini dene

Akciğer ultrasonunda dinamik hava bronkogramını inceleyen Lichtenstein çalışmasında pnömoni ve rezorptif atelektazi için hangi oranlar bildirilmiştir (BT bulgusu değildir)?
Cevabı göster
Pnömonide %62, atelektazide %6. İncelenen çalışmada dinamik hava bronkogramları pnömoni olgularının %62’sinde, atelektazi olgularının %6’sında görülmüştür.
Mukus tıkacıyla ilişkili obstrüktif atelektazide aşağıdakilerden hangisi doğrudur?
Cevabı göster
Mukus tıkacı, obstrüksiyona bağlı atelektazi için hareketli bir materyal örneğidir. Mukus tıkacı gibi hareketli bir materyalin oluşturduğu tıkanıklık gerçek zamanlı görüntülemede açıldığında, hava bronkogramı statik görünümden dinamik görünüme geçebilir.

İlgili konular

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 30 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.