Supin BT’de okült pnömotoraks

Özet

Supin çekilen travma BT’sinde plevral hava, yerçekimine bağlı olarak çoğu kez apeks yerine anterior ve anteromedial reseslerde ince bir tabaka oluşturur. Bu dağılım, eşlik eden supin akciğer grafisi normal görünse bile BT’de saptanabilir. Tanınması özellikle pozitif basınçlı ventilasyon, eşlik eden akciğer yaralanması veya artan solunum sıkıntısı bulunan hastada önem taşır. Küçük bir hava cebinin atlanması pnömotoraksın ilerleyişinin ve ilişkili yaralanmaların fark edilmesini geciktirebilir.

Faz ve pencere

Kontrastsız tanısal

Sırtüstü pozisyonda plevral hava başlangıçta en az bağımlı anteromedial ve subpulmonik reseslerde birikir. Supin BT’de, supin grafide görülmeyen pnömotoraks saptanabilir.

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

BT bulguları

• Anterior plevral hava: göğüs duvarının hemen iç yüzü boyunca, visseral plevra ile parietal plevra arasında ince siyah hilal.
• Visseral plevra çizgisi: hava ile komşu kollabe akciğerin sınırını belirleyen ince, keskin çizgi; çizginin periferinde damar işaretleri bulunmaz.
• Anteromedial uzanım: hava kalp veya mediasten kenarına komşu ilerleyebilir; supin incelemede yalnız apikal görüntülere bakmak yeterli değildir.
• İnterlobar fissür boyunca hava: küçük pnömotoraksta fissür plevra yüzleri arasında sınırlı hava görülebilir.
• Komşu akciğerde kontüzyon veya laserasyon, plevral havanın olası travmatik kaynağını gösteren eşlikçi parankim bulgularıdır.
• Derin sulkus ve keskin kalp kenarı, BT tanısının yerine geçmeyen; supin grafide aranabilecek dolaylı ipuçlarıdır.
• Büyük pnömotoraksta artmış intraplevral basınca bağlı ipsilateral hemidiyafram depresyonu supin grafide görülebilecek dolaylı bir bulgudur.

Normalde

Normal supin BT’de plevral boşlukta anormal hava birikimi görülmez. Pnömotoraks şüphesinde anterior kostal plevra boyunca visseral çizginin varlığına ve çizginin dışındaki alanda damar işaretlerinin kaybolmasına bakılır.

Ayırıcı tanı

Cilt kıvrımları, pnömotoraksı taklit edebilen görüntüleme bulgularındandır.

Apikal büller pnömotoraksı taklit edebilir.

Fissür içi hava

plevral hava fissür düzlemini izleyebilir; komşu lobların konturları takip edilerek parankimal kaviteden ayrılır.

Tuzaklar

• Pnömotoraks, servikal BT serisinin pulmoner pencere görüntülerinde saptanabilir.
• Tek aksiyel kesitteki ince çizginin niteliği belirsizse, BT görüntülerinde hava koleksiyonunun yerini değerlendir.

Kendini dene

1. Supin travma BT’sinde, önceki supin akciğer grafisinde görülmeyen anterior plevral hava ve akciğer kenarında damarların kesildiği çizgi görülüyor. Tanı nedir?

   • Okült pnömotoraks
   • Büllöz amfizem
   • Plevral efüzyon
   • Akciğer kontüzyonu
   Cevabı göster

   Okült pnömotoraks. Plevral hava ile damar içermeyen visseral plevra çizgisinin birlikte görülmesi pnömotoraksı gösterir. Bül parankim içindedir; efüzyon sıvı atenüasyonundadır; kontüzyon hava tabakası oluşturmaz.

2. Plevra dışındaki ince siyah çizgi göğüs duvarı boyunca uzanıyor; derininde akciğer damarları kesintisiz. En olası taklitçi hangisidir?

   • Cilt kıvrımı
   • Hemotoraks
   • Ampiyem
   • Atelektazi
   Cevabı göster

   Cilt kıvrımı. Cilt kıvrımı göğüs duvarı dışındadır ve altındaki akciğer damarları devam eder. Hemotoraks ve ampiyem plevral sıvı oluşturur; atelektazi akciğer hacim kaybıdır.

Kaynaklar

Bu sayfadaki 33 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 9 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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