Renal arter anevrizması ve psödoanevrizma

Özet

Renal arter anevrizması sıklıkla başka bir nedenle çekilen BT'de fark edilir; psödoanevrizma ise travma, biyopsi veya cerrahi sonrası gelişebilen, rüptür ve kanama riski taşıyan edinilmiş damar hasarıdır. BT anjiyografi kese ile ana arter arasındaki bağlantıyı ve gerçek lümenle ilişkisini göstererek tanıyı ve damar anatomisini ortaya koyar. Anevrizmanın boyutu, morfolojisi ve yeri ile ilgili arter ve çıkan dallar tarif edilir. Eşlik eden kanama ya da segmental perfüzyon kaybı fark edilmezse acil klinik kötüleşme ve renal doku kaybı olabilir.

Faz ve pencere

Kontrastsız

Kontrastsız BT’de anevrizma kesesinin boyutu, şekli ve yerleşimi değerlendirilebilir; damar anatomisini ve lezyonun özelliklerini karakterize etmek için BT anjiyografi kullanılabilir.

BTA tanısal

Arteriyel kontrast fazında renal arterle bağlantılı, keseye giden dar veya geniş boyun ve besleyici damar izlenir; BT anjiyografi lezyonun boyutunu, şeklini ve yerleşimini karakterize eder ve damar anatomisini ortaya koyar.

Gecikmiş

BT anjiyografi renal arter psödoanevrizmasının tanısında temel yöntemdir; BT, anevrizma rüptürünü ve aktif kanamayı da gösterebilir.

BT bulguları

• Renal arterden çıkan, kontrastla arteriyel kan havuzuna benzer biçimde dolan sakküler veya füziform kese.
• Anevrizmanın boyutu, morfolojisi ve yeri ile ilgili arter ve çıkan dallar tarif edilir.
• Psödoanevrizmada travma, biyopsi veya parsiyel nefrektomi alanına komşu, arterle dar boyun üzerinden devamlı kontrastlanan yuvarlak odak.
• Aktif rüptürde kese dışına şekilsiz kontrast kaçışı ve perirenal/retroperitoneal hematom.
• Distal dal embolisi veya trombozuna bağlı kama biçimli segmental kortikal hipoenhansman.
• BT, renal arter anevrizması ve psödoanevrizmasının boyutunu, şeklini ve yerleşimini karakterize edebilir.
• Renal arter anevrizmaları sakküler, füziform veya diseksiyonla ilişkili olabilir; psödoanevrizma ise damar duvarı hasarı sonrası oluşan ve arter lümeniyle iletişimini sürdüren ayrı bir lezyondur.

Ölçütler ve sınıflamalar

Gerçek renal arter anevrizması tanımı

Komşu hastalıksız arter segmentinin çapının >1,5 katı

Morfolojik renal arter anevrizması tipleri

Sakküler veya füziform gerçek anevrizma; intraparenkimal dallarda sakküler psödoanevrizma görülebilir. Psödoanevrizma, damar duvarının tüm katlarını içeren gerçek anevrizmadan farklı olarak damar yırtığı sonrası çevre dokuyla sınırlanmış kandır.

Normalde

Normal renal arter abdominal aortadan çıkar, hilusa ilerler ve dallara ayrılır; lümen boyunca dışa doğru keseleşme ya da lümenle aynı kontrastı alan odak yoktur. BT, MR ve dijital çıkarım anjiyografi renal arter lezyonunun boyutunu, şeklini ve yerleşimini karakterize edebilir.

Ayırıcı tanı

Psödoanevrizma, arter duvarı yırtığı sonrası oluşan ve komşu arter lümeniyle iletişim kuran periarteriyel hematomdur; tanıda BT anjiyografi başlıca yöntemdir.

Renal arteriovenöz malformasyon

tek kese yerine serpijinöz damar yumağı ve erken renal ven dolumu gösterir.

Renal kist

arter lümeniyle devamlılığı yoktur ve arteriyel fazda kan havuzu gibi kontrastlanmaz.

İntraparenkimal renal arter anevrizması, renal tümörü taklit edebilir; BT anjiyografide kitleye uzanan şüpheli besleyici arter görülebilir.

Renal arter diseksiyonu intimal yırtılma ve ardından trombüs oluşumuyla gelişebilir; travmatik olgularda devaskülarizasyona yol açabilir ve diseksiyonla ilişkili anevrizmalar da görülebilir.

Tuzaklar

• BT, renal arter anevrizmasının boyutunu, şeklini ve yerleşimini karakterize edebilir.
• Psödoanevrizma aktif kanama odağına benzeyebilir; sınırlı yuvarlak kese biçimi ve besleyici arterle boyun ilişkisini ara.
• Renal arter anevrizması, renal tümörü taklit edebilir; BT anjiyografide kitleye uzanan şüpheli besleyici arter görülebilir.
• Psödoanevrizma değerlendirmesinde BT anjiyografi tanıda temel yöntemdir; psödoanevrizma, komşu arter lümeniyle iletişim kuran perfüze bir hematomdur.

Kendini dene

1. Arter duvarı yırtığı sonrası çevre dokularla sınırlanan periarteriyel hematom olarak tanımlanan lezyon hangisidir?

   • Psödoanevrizma
   • Renal kist
   • Arteriovenöz malformasyon
   • Renal hücreli karsinom
   Cevabı göster

   Psödoanevrizma. Psödoanevrizma, arter duvarı yırtığı sonrası damar çevresi dokularla sınırlanan hematomdur.

2. Renal arter anevrizması veya psödoanevrizması şüphesinde görüntüleme yöntemleri lezyonun hangi özelliklerini karakterize edebilir?

   • Lezyonun boyutu, şekli ve yerleşimi
   • Üreteral reflüks derecesi
   • Glomerüler filtrasyon hızı
   • Böbrek korteks kalınlığı
   Cevabı göster

   Lezyonun boyutu, şekli ve yerleşimi. Kaynaklar, BT, MR ve dijital çıkarım anjiyografinin lezyonun boyutunu, şeklini ve yerleşimini karakterize edip damar anatomisini değerlendirmeye yardımcı olduğunu belirtir.

İlgili konular

• Renal infarkt
• Akut renal kortikal nekroz
• Renal ven trombozu
• Renal arter diseksiyonu ve trombozu

Kaynaklar

Bu sayfadaki 38 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 21 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.