Renal agenezi ve hipoplazi BT bulguları

Özet

Renal agenezide bir böbrek doğuştan gelişmemiştir; renal hipoplazide ise böbrek küçük olmakla birlikte gelişmiş parankim ve toplayıcı sistem içerir. BT'nin temel katkısı boş renal fossada gerçekten böbrek dokusu bulunmadığını göstermenin yanı sıra ektopik, füzyone veya cerrahi olarak çıkarılmış bir böbreği aramaktır; damar haritalaması gerekiyorsa uygun BT anjiyografi protokolü ayrıca değerlendirilir. Hipoplastik böbreğin düzgün konturlu, orantılı küçük görünümü; edinilmiş skarlı atrofideki parankimal çentik ve kaliks deformasyonundan ayrılmalıdır. Ektopik böbreğin ya da konjenital tek böbreğin gözden kaçması taş, enfeksiyon veya girişim planlamasında yanlış taraf ve yanlış anatomi varsayımına yol açabilir.

Faz ve pencere

Portal tanısal: Kontrastlanan renal parankimi ve varsa ektopik/füzyone böbreğin yerini tüm abdomen-pelvis boyunca gösterir; karşı böbreğin kompansatuvar büyümesi ve eşlik eden üriner komplikasyonlar değerlendirilebilir. Renal arterlerin varyant dalları ameliyat veya girişim öncesi önemliyse uygun arteriyel faz BT anjiyografiyle haritalanır.

Önerilen pencereler: Batın (G 400 / M 50), Yumuşak doku (G 400 / M 40).

BT bulguları

Agenezide beklenen renal fossada renal parankim görülmez; tanı koymadan önce pelviste ve diğer olası ektopik konumlarda böbrek dokusu aranır.
Tek böbrek varsa karşı böbrekte kompansatuvar hacim artışı görülebilir; renal fossanın boşluğuyla birlikte değerlendirilir.
Hipoplazik böbrek hacimce küçük ve dış konturu düzgün olabilir; kaliksler skara bağlı çekinti veya belirgin genişleme göstermez. Gelişmiş bir parankim ve toplayıcı sistem bulunması ageneziden ayırır.
Reflü nefropatisi veya kronik piyelonefritte küçülme çoğu kez fokal kortikal çentikler, parankim incelmesi ve altındaki künt/deforme kaliksle birliktedir.
Ektopik böbrekte pelvis ya da daha yukarı yerleşim, rotasyon farklılığı ve birden fazla veya olağandışı seyirli damar görülebilir; çapraz füzyonlu ektopide parankim orta hatta birleşebilir.

Normalde

Çoğu kişide her böbreğin tek renal arteri abdominal aortadan L2 vertebra düzeyinde çıkar; böbreği besleyen birden fazla arter olguların yaklaşık %24’ünde görülür. Şüpheli tarafta yalnızca fossaya değil tüm pelvis ve abdomen boyunca böbrek dokusuna, adrenal bez şekline ve karşı böbrek hacmine bakın; hipoplazide küçük fakat mevcut parankim ve kaliksler, agenezide ise renal doku yokluğu aranır.

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 s0119; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Pelvik veya başka ektopik böbrek: renal fossada boşluk vardır ancak parankim abdomenin alt kesimlerinde veya alışılmadık konumda saptanır.
Çapraz füzyonlu ektopi: iki böbrek aynı tarafta bulunabilir ve orta hatta birleşen parankim/kolektör sistemi karşı tarafın boş görünmesine yol açar.
Atrofik/skarlı böbrek: parankim kalıntısı, düzensiz kortikal çentikler ve eşlik eden kaliks deformasyonu edinilmiş hasarı destekler.
Nal bantlı böbrekte isthmik füzyon, böbreklerin yönelimini ve anatomik yerleşimini değiştirebilir.

Tuzaklar

Boş renal fossa tek başına agenezi değildir; küçük, atrofik, ektopik veya füzyone böbrek tüm kesitlerde aranmalıdır.
Tek taraflı küçük böbrekte fokal kortikal çentik ve papilla küntleşmesi ya da kaliks genişlemesi reflü nefropatisi veya kronik piyelonefrite bağlı skarı destekler.

Kendini dene

Bir renal fossa boş göründüğünde, ektopik böbreğin gözden kaçmasını önlemek için hangi olasılık özellikle akılda tutulmalıdır?
Cevabı göster
Ektopik böbreğin renal ageneziyle karıştırılması. Ektopik böbrek renal agenezi sanılabilir; bu nedenle anormal böbrek konumu araştırılmalıdır.
Oligomeganefroni için kaynakta tarif edilen BT bulgularından hangisi uygundur?
Cevabı göster
Küçük böbreklerde kalın korteks ve medulla. Oligomeganefronide küçük böbrekler normal böbrek şeklini koruyabilir; korteks ve medulla kalınlaşması, ayrıca çizgili nefrogram görülebilir.

İlgili konular

Kaynaklar

Bu sayfadaki 30 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 4 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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