Trakeal tümör ve endoluminal kitle

Özet

Trakeadaki endoluminal kitleler primer tümör, komşu organdan doğrudan invazyon veya daha seyrek metastaz kaynaklı olabilir; benign görünümlü bir nodül de hava yolunu daraltabilir. Doğrudan bronkoskopinin derin katmanları ve komşu dokuyu değerlendirememesini tamamlayan çok dedeanator BT, trakeal duvarın ve komşu yapıların değerlendirilmesinde anahtar rol oynar. Kontrastlı inceleme neoplazilerin değerlendirilmesinde yararlı olabilir. Lezyon atlanırsa sabit santral obstrüksiyon, tekrarlayan enfeksiyon veya distal atelektazi açıklanamadan kalabilir.

Faz ve pencere

Kontrastsız tanısal

İnce kesitler endoluminal yumuşak doku, kalsifikasyon, yağlı alanlar ve hava yolu tıkanıklığını gösterir; yağ dansiteli alanlar ve kalsifikasyon birlikte hamartoma lehine olabilir.

Portal tanısal

Kontrastlı BT, trakeal neoplazilerde kitlenin endoluminal ve ekstraluminal bileşenlerini göstermeye yardımcı olabilir.

Önerilen pencereler: Mediasten (G 350 / M 50), Akciğer (G 1500 / M -600).

BT bulguları

• Trakea duvarından kaynaklanan polipoid, sessil veya çevresel yumuşak doku kitlesi
• Skuamöz hücreli karsinom BT'de eksantrik hava yolu daralması veya çevresel duvar kalınlaşması şeklinde görülebilir.
• Koronal-sagittal düzlemlerde kraniokaudal uzanım; carina ve subglottik bölgeyle mesafe
• Posterior membran veya kıkırdak halkalara göre kitlenin duvar yerleşimi
• Dışa taşan bileşen, mediastinal yağ planı kaybı ve özofagus/tiroid/akciğerle temas
• Kontrastlanma, iç kalsifikasyon veya makroskopik yağ gibi ayırıcı tanıya yardım eden doku özellikleri
• Distal hava hapsi, mukus birikimi, postobstrüktif pnömoni veya atelektazi

Ölçütler ve sınıflamalar

Primer trakeal tümörlerde başlıca histolojik tipler

Erişkin primer trakeal malignitelerinde en sık skuamöz hücreli karsinom ve adenoid kistik karsinom görülür; oranlar seriye göre değişir. Daha seyrek tipler arasında mukoepidermoid karsinom, karsinoid/nöroendokrin tümörler, diğer karsinomlar ve sarkomlar bulunur; benign tümörler de görülebilir. Trakeal kitlelerin tanı ve prognozu için BT bulgularının yanı sıra kesin histopatolojik doğrulama şarttır.

Normalde

Trakea duvarı ve hava yolu MDCT ile değerlendirilebilir. Şüpheli odakta nodüler fokal bir lezyon tümör olasılığını artırır; MDCT hava yolu duvarını ve komşu dokuları değerlendirmeye yardımcı olur.

Ayırıcı tanı

Alerjik bronkopulmoner aspergillozda BT'de mukus tıkaçları görülebilir.

Trakeal stenoz

düzgün skar daralması; belirgin nodüler yumuşak doku kitlesi yok

Amiloidoz

çok odaklı nodüler duvar kalınlaşması ve olası kalsifikasyon

Papillomatozis

birden fazla küçük lüminal nodül; bronşlara yayılabilir

Dıştan invazyon

trakea lümeni içinden başlayan kitle yerine komşu organ kitlesiyle kesintisiz uzanım

Tuzaklar

• Alerjik bronkopulmoner aspergillozda BT'de mukus tıkaçları görülebilir; MDCT büyük hava yolu hastalıklarının tanımlanmasına yardımcı olur.
• İntratorasik tiroid, özofagus veya akciğer kitlesi trakeayı dıştan daraltabilir; kaynak organı ve yağ planlarını izle.
• Yalnız aksiyel kesit tümörün subglottik ya da carinal uzanımını eksik gösterir; sagittal ve koronal reformasyonları ekle.
• Trakeal kitlelerin tanı ve prognozu için BT bulgularının yanı sıra kesin histopatolojik doğrulama şarttır.

Kendini dene

1. Merkezi hava yolu BT'sinde nodüler fokal lezyon görülmesi hangi olasılığı artırır?

   • Tümör
   • Yaygın hava yolu genişlemesi
   • Solunumla değişen hava yolu kollapsı
   • Normal anatomik görünüm
   Cevabı göster

   Tümör. Nodüler fokal hava yolu lezyonlarının tümör olma olasılığı daha yüksektir.

2. Hava yolu BT'sinde lümen içinde mukus tıkacı görülüyor. Bu lüminal bulgunun olası açıklaması nedir?

   • Sekresyon tıkacı
   • Adenoid kistik karsinom
   • Skuamöz hücreli karsinom
   • Trakeal papillom
   Cevabı göster

   Sekresyon tıkacı. Mukus tıkaçları, alerjik bronkopulmoner aspergillozda BT'de görülebilir.

İlgili konular

• Trakeal stenoz
• Endobronşiyal tümör

Kaynaklar

Bu sayfadaki 38 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 18 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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