Renal arter diseksiyonu ve trombozu

Özet

Renal arter diseksiyonunda intimal yırtık kanı damar duvarına veya yalancı lümene yönlendirerek gerçek lümeni daraltabilir; eşlik eden tromboz distal perfüzyonu bozabilir. MDCT’de renal arter diseksiyonu intimal flep veya tromboze yalancı lümene bağlı gerçek lümen stenozuyla, renal infarkt ise parankimal perfüzyon defektiyle gösterilebilir. İnce flep, eksantrik mural hematom, yalancı lümen ya da ani dal kesilmesi doğrudan damar işaretleridir. Damar lezyonunun atlanması böbrek iskemisinin kaynağını ve olası iki taraflı/ana arter tutulumunu gözden kaçırabilir.

Faz ve pencere

BTA tanısal

Arteriyel fazlı ince kesit BT'de renal arter boyunca intimal flep, tromboze yalancı lümen ve bu duruma bağlı gerçek lümen daralması izlenir.

Nefrografik

Nefrografik parankim fazında diseksiyonun beslediği segmentte kama biçimli parankimal perfüzyon defekti görülebilir.

Önerilen pencereler: Anjiyo (G 600 / M 150), Batın (G 400 / M 50).

BT bulguları

• Renal arter lümeni içinde intimal flep, gerçek ve yalancı lümen sınırını belirten çizgisel bir yapı olarak izlenebilir.
• Renal arter duvarı boyunca uzanan eksantrik düşük atenüasyonlu alan, tromboze olmuş yalancı lümen veya intramural hematomu düşündürebilir.
• Yalancı lümen tromboze olduğunda renal arter duvarı boyunca eksantrik düşük atenüasyonlu bir alan izlenir.
• Trombüs, renal arterde dolum defekti veya damarın ani sonlanması şeklinde görünür; distal dal opasifikasyonu azalabilir.
• İlgili dalın beslediği parankimde kama biçimli perfüzyon defekti renal infarkt ile uyumludur.
• Renal arter diseksiyonuna fibromüsküler displazi eşlik edebilir.

Ölçütler ve sınıflamalar

BT’de renal arter diseksiyonu lehine doğrudan bulgular

BT’de tanı, renal arterde intimal flep görülmesine veya tromboze yalancı lümeni düşündüren eksantrik mural düşük atenüasyona dayanır.

Normalde

Normal renal arter BTA’da aortadan çıkan ana gövde düzenli çapta ve homojen kontrast dolumuyla segmental dallara ayrılır; lümen içinde çizgisel flep veya duvar boyunca eksantrik dolum kusuru bulunmaz. Damar lezyonu değerlendirilirken karşı böbrek ve aort ile karşılaştırma yapılmalı, çok düzlemli rekonstrüksiyonlarda damar yolu takip edilmelidir.

Ayırıcı tanı

Renal arter embolisinde MDCT’de intra-arteriyel dolum defekti görülebilir; diseksiyon lehine intimal flep veya tromboze yalancı lümene ait eksantrik mural düşük atenüasyon aranır.

Fibromüsküler displazi

damar duvarında karakteristik 'string-of-beads' (boncuk dizisi) görünümü oluşturur; akut intimal flep veya mural hematom oluşturmaz.

Renal arter anevrizması, takip görüntülemesinde renal arterde anevrizmal değişiklik olarak izlenebilir.

Aort diseksiyonunun renal artere uzanımı

intimal flep aortada da izlenir ve renal ostiuma uzanabilir; tüm aorta ve ana dallar taranmalıdır.

Vazospazm

damarda düzgün, geçici daralma oluşturabilir; damar duvarında flep, mural hematom veya yalancı lümen yoktur.

Tuzaklar

• Küçük intimal flep parsiyel hacim etkisiyle kaybolabilir; renal arter boyunca aksiyel kesitlerin yanında koronal ve oblik rekonstrüksiyonları da incele.
• Tromboze yalancı lümen, eksantrik düşük atenüasyonlu mural trombüs şeklinde görünebilir; gerçek lümen daralması ve flebin uzantıları dikkatle taranmalıdır.
• Parankimde infarkt görüp renal arterleri incelemeyi bırakma; diseksiyon ince, ana gövdeye sınırlı veya segmental dal düzeyinde olabilir.
• Tek taraflı damar lezyonu saptansa bile karşı renal arter ve aortayı kontrol et; yaygın diseksiyon/arteriyopati eşlik edebilir.

Kendini dene

1. BTA'da renal arter lümeninde intimal flep ve distal parankimde kama biçimli hipoenhans alan var. Tanı?

   • Renal arter diseksiyonu
   • Fibromüsküler displazi
   • Renal arter anevrizması
   • Vazospazm
   Cevabı göster

   Renal arter diseksiyonu. Renal arterde intimal flep diseksiyon için MDCT tanı ölçütüdür; parankimal perfüzyon defekti ise renal infarkt bulgusudur ve kama biçimli olabilir.

2. Akut renal infarktta MDCT'de renal arter içi dolum defekti doğrudan hangi nedeni destekler?

   • Renal arter embolisi
   • Renal arter diseksiyonu
   • Aort diseksiyonu
   • Fokal piyelonefrit
   Cevabı göster

   Renal arter embolisi. MDCT'de intra-arteriyel dolum defekti, çalışmada emboli için tanımlanan tek doğrudan işarettir. Bu sorunun açıklamasında diseksiyonun tanısal ölçütlerini ayrıca sıralamak gerekmez; emboli seçeneğini destekleyen doğrudan bulgu arter içi dolum defektidir.

İlgili konular

• Renal infarkt
• Akut renal kortikal nekroz
• Renal ven trombozu
• Renal arter anevrizması veya psödoanevrizması

Kaynaklar

Bu sayfadaki 35 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.