Özofagus divertikülü

Özet

Özofagus divertikülü, özofagus lümeniyle bağlantılı kese biçimli çıkıntıdır; yeri ve duvar katlarının katılımına göre Zenker, traksiyon ve epifrenik tipler düşünülür. BT, özellikle tesadüfen saptanan kesenin içeriğini, komşu mediastinal yapılarla ilişkisini ve enfeksiyon ya da perforasyon gibi bölgesel komplikasyonları gösterir. Ağızdan verilen kontrast keseye geçerse lümen bağlantısını görünür kılabilir, ancak rutin tanısal incelemede özofagografi daha duyarlı olabilir. Kese içindeki retansiyon, inflamasyon veya perforasyonun atlanması aspirasyon ve mediastinal enfeksiyonun fark edilmesini geciktirebilir.

Faz ve pencere

Portal tanısal

BT'de distal özofagus duvarından dışa uzanan, hava-sıvı düzeyli kese görülebilir.

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

BT bulguları

• Özofagus duvarından dışa uzanan, lümenle boyun üzerinden ilişkili hava, sıvı veya gıda içerikli kese
• Zenker divertikülünde hipofarenks-özofagus bileşkesinin posteriorunda, krikofaringeal düzeyin üzerinde kese
• Traksiyon divertikülünde orta torasik özofagustan dışa doğru uzanan, komşu mediastinal fibrotik değişikliklerle ilişkili çıkıntı
• Epifrenik divertikülde distal özofagusun sağ veya sol yanında, gastroözofageal bileşkeye yakın kese
• Retansiyon içeriği olarak kese içinde hava-sıvı seviyesi veya oral kontrast birikimi
• İnflamasyon düşündüren kese duvarında kalınlaşma ve çevre mediastinal yağda bulanıklık
• Divertikül onarımı sonrası kontrast incelemede farengoözofageal bileşkeden fistül traktına kaçak görülebilir.
• Zenker divertikülü genellikle pulsiyon tipi yalancı divertiküldür; orta torasik traksiyon divertikülü çoğunlukla gerçek divertikül, epifrenik divertikül ise çoğunlukla motilite bozukluğuyla ilişkili pulsiyon tipi yalancı divertiküldür.

Normalde

Özofagus divertikülü, özofagus mukozasının veya tüm duvar yapısının özofagus duvarı dışına herniye olmasıyla oluşur. Şüpheli kesenin özofagus duvarıyla devamlılığını değerlendirin.

Ayırıcı tanı

Özofagus duplikasyon kisti

çoğu lümenle bağlantısız, sıvı yoğunluklu ve duvarla ortak sınırlı kistik oluşumdur.

Hiatal herni

görüntülemede diafragmanın üstüne geçen herni kesesi ve gastroözofageal bileşkenin yukarı kayması izlenir; divertikül benzeri yapı bulunmaz.

Özofagus tümörü

duvar merkezli yumuşak doku kitlesi lümeni daraltır; hava-sıvı içeren ve boyunla lümene açılan kese beklenmez.

Paraözofageal apse

düzensiz duvarlı koleksiyon ve çevre yağ dokusunda inflamasyon vardır, normal bir divertikül boynu gösterilemeyebilir.

Tuzaklar

• Özofagus divertikülünün değerlendirilmesinde baryumlu özofagografi tanıyı kolaylaştırır.
• Özofagus divertikülünde inflamatuvar duvar değişiklikleri ve başka komplikasyonlar görülebilir.
• Zenker divertikülünde kesenin hipofarenkste, krikofaringeal kasın üstünde yerleştiğini; Killian-Jamieson divertikülünde ise krikofaringeal kasın altında ve daha anterolateral çıkış bulunduğunu ayırıcı değerlendirmede göz önünde bulundurun.

Kendini dene

1. Distal özofagus yanında hava-sıvı içeren kese görülüyor; lümenle bağlantısı gastroskopiyle doğrulanıyor. En olası tanı nedir?

   • Epifrenik divertikül
   • Duplikasyon kisti
   • Leiomyom
   • Hiatal herni
   Cevabı göster

   Epifrenik divertikül. Distal özofagusa boyunla açılan kontrast dolu kese divertikülü destekler. Gastrointestinal duplikasyon kistleri komşu yapıdan ayrı olup ortak duvar paylaşabilir; hiatal hernide abdominal organlar özofagus hiatusundan toraksa geçer.

2. Özofagus divertikülüne ikincil bronkoözofageal fistülde bildirilen komplikasyonlardan biri hangisidir?

   • Tekrarlayan pnömoni
   • Akut aort sendromu
   • Pulmoner emboli
   • Özofagus varisi
   Cevabı göster

   Tekrarlayan pnömoni. Bronkoözofageal fistül tekrarlayan pnömoniye yol açabilir.

Kaynaklar

Bu sayfadaki 33 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 12 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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