Özofagus varisleri

Özet

Özofagus varisleri portal hipertansiyon nedeniyle gelişen, özofagus duvarı içindeki genişlemiş venöz kollaterallerdir ve sirozlu hastada üst gastrointestinal kanamanın önemli nedenlerindendir. Portal venöz fazlı BT, lümen çevresinde ya da lümene kabaran ve portal venöz kanla benzer biçimde kontrastlanan kıvrımlı damarları gösterebilir; aynı incelemede gastrik ve diğer portosistemik kollateraller de haritalanabilir. BT varislerin varlığını ortaya koyabilir, ancak kanama riskinin ve endoskopik görünümün değerlendirilmesinde endoskopinin yerini almaz. Varislerin fark edilmemesi portal hipertansiyonun ve olası kanama kaynağının raporda atlanmasına neden olabilir.

Faz ve pencere

Portal tanısal

Portal venöz fazda özofagus duvarı içindeki ve paraözofageal yağdaki yuvarlak, tübüler veya serpijinöz kanallar portal ve mezenterik venlerle benzer düzeyde kontrastlanır; inceleme damar devamlılığını izlemeye elverişlidir.

BT bulguları

• Özofagus lümeni boyunca duvar içinde lümene kabaran yuvarlak veya kıvrımlı kontrastlanan venöz kanallar
• Özofagus dış çevresindeki paraözofageal kollaterallerin azygos, hemiazygos veya vertebral venöz pleksusa uzanan serpijinöz seyri
• Distal özofagus ve gastroözofageal bileşkede belirginleşen submukozal venöz yapılar
• Sol gastrik venin genişlemesi ve gastroözofageal bileşke çevresinde gastrik kollateraller
• Portal hipertansiyon eşlikçileri olarak splenomegali, asit, karaciğer kontur nodülaritesi veya portosistemik şantlar

Normalde

Aynı torasik düzeyde normal özofagus çevresinde portal venöz fazda lümen boyunca uzanan serpijinöz, kanla dolu kontrastlanan kanallar görülmez; özofagus duvarı düzgün yumuşak doku konturundadır. Kıyaslarken lümene kabaran damarları özofagus lümeninden ayır ve kesitler boyunca sol gastrik ven ya da azygos sistemiyle devamlılığını izle.

Ayırıcı tanı

Özofagus intramural hematomu

kontrastsızda yüksek atenüasyonlu duvar içi kitle ve lümen basısı yapar; varis gibi portal venöz kanla kontrastlanmaz.

Özofagus leiomyomu

düzgün sınırlı solid duvar kitlesi olarak lümeni iter; kesitler boyunca venöz ağa devam etmez.

Tuzaklar

• Paraözofageal varisler özofagus duvarındaki varislerden ayrıdır; her iki kompartımanı da incele ve damarları çok düzlemli görüntülerde izle.
• Tek bir kesitte damar kesiti lenf nodu ya da kitle gibi görünebilir; seri kesitlerde tübüler-serpijinöz devamlılık ve venöz faz kontrastlanması aranmalıdır.
• BT'de varis görülmesi endoskopik kanama riskini tek başına derecelendirmez; aktif kanama odağı yokluğu varis yokluğu anlamına gelmez.
• BT’de görülen varisler portal hipertansiyonun ve kollaterallerin anatomik değerlendirmesine katkı sağlar; varislerin endoskopik varlığını ve derecesini belirlemede üst endoskopi referans yöntemdir.

Kendini dene

1. Sirozlu hastanın portal venöz fazlı BT'sinde distal özofagus çevresinde portal venle aynı düzeyde kontrastlanan serpijinöz kanallar görülüyor. Tanı nedir?

   • Özofagus varisleri
   • Özofajit
   • İntramural hematom
   • Leiomyom
   Cevabı göster

   Özofagus varisleri. Portal venöz fazda venöz kanla benzer kontrastlanan, lümen çevresinde kıvrımlı kanallar varisleri destekler. Özofagus varisleri BT'de düzgün sınırlı, yuvarlak, tübüler veya serpijinöz yapılar olarak görülür ve komşu portal ve mezenterik venlerle benzer kontrastlanır.

2. Özofagusun yanında görülen yuvarlak yumuşak doku odağı kesitler boyunca azygos venine bağlanıyor ve portal fazda kontrastlanıyor. En olası yapı nedir?

   • Paraözofageal varis
   • Lenf nodu
   • Duplikasyon kisti
   • Özofagus karsinomu
   Cevabı göster

   Paraözofageal varis. Tübüler devamlılık, azygos bağlantısı ve venöz kontrastlanma paraözofageal kollateral lehinedir. Paraözofageal varisler özofagusu çevreleyen çoklu venöz kollaterallerdir ve koroner veni azygos, hemiazygos venler ile vertebral pleksusa bağlar.

Kaynaklar

Bu sayfadaki 32 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 2 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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