Renal ektopi ve çapraz ektopi BT bulguları

Özet

Renal ektopide böbrek normal konumunda değildir; çapraz ektopide böbrek karşı tarafta bulunur ve üreteri orta hattı geçerek ortotopik taraftaki mesaneye açılır. Kontrastlı BT, ektopik böbreğin yerini, üreter seyrini ve damar anatomisini aynı incelemede göstermeye yardımcı olur. Bu varyant çoğu zaman tesadüfen saptanır; taş, enfeksiyon ve obstrüksiyonla ilişkili olabilir ve anomalili anatomi girişim planlamasını etkileyebilir. Ektopik böbreği renal agenezi sanmak tanıyı geciktirebilir; anomalili anatominin fark edilmemesi cerrahi veya girişim sırasında istem dışı yaralanmaya yol açabilir.

Faz ve pencere

Kontrastsız tanısal: Renal fossada böbrek yokluğu, pelvis/iliak bölgede böbrek konturu, rotasyon ve kalkül/hidronefroz görülür; damar pedikülü ve toplayıcı sistem devamlılığı değerlendirilmez.
Nefrografik tanısal: Kontrastlı BT'de ektopik parankimin kontrastlanması ve kortikomedüller farklılaşmasının korunması renal dokunun tanınmasına; parankim devamlılığının değerlendirilmesi ise füzyon durumunun belirlenmesine yardımcı olur.
BTA tanısal: Ektopik böbreğe aortanın distalinden veya iliak arterlerden çıkan tekil/çoklu arterler ve venöz dönüş gösterilir; ameliyat veya girişim öncesi damar haritası için kullanılır.
Gecikmiş: Seçilmiş BT ürografi serisinde ektopik böbreğin kaliks-pelvis sistemi ve üreterinin mesaneye dönüş yolu izlenir; basit yerleşim varyantı için zorunlu değildir.

Önerilen pencereler: Batın (G 400 / M 50), Yumuşak doku (G 400 / M 40), Kemik (G 1800 / M 400).

BT bulguları

Beklenen renal fossada parankim ve renal sinüsün bulunmaması; cerrahi öykü yoksa alt karın/pelviste ektopik böbrek arayışı.
Pelvik, iliak veya daha nadiren abdominal yerleşimli, renal korteks-medulla mimarisini koruyan parankim.
Ektopik böbrekte hilusun öne veya yana bakmasıyla belirgin malrotasyon ve değişmiş uzun eksen.
Çapraz ektopide iki renal ünite aynı tarafta bulunabilir; ektopik böbreğin üreteri orta hattı geçerek karşı taraftaki mesaneye açılır.
Çapraz füzyonda iki renal parankim arasında birleşme; sık görülen alt pol-üst pol füzyonu veya L/S biçimli konfigürasyon.
Distal aorta ya da iliak damarlardan ektopik böbreğe uzanan, bazen çoklu ve kısa renal arterler.
Ektopik böbreğe taş ve obstrüksiyon eşlik edebilir.

Ölçütler ve sınıflamalar

Yerleşime göre renal ektopi: Basit ektopide böbrek aynı tarafta, çoğunlukla pelviste; daha nadiren toraks gibi başka bir anormal konumda bulunur. Çapraz ektopide böbrek karşı tarafta bulunur; füzyonlu ya da füzyonsuz olabilir. Çapraz füzyonlu ektopinin tanımlanmış biçimleri arasında sigmoid (S), L, disk ve kitle (lump) konfigürasyonları bulunur.

Normalde

Normal böbrekler yaklaşık L1-L3 düzeyinde retroperitoneal renal fossalarda, uzun eksenleri oblik ve hilusları mediale dönük olarak görülür; her renal arter hilusa doğru izlenir. Ektopi şüphesinde her iki fossayı, pelvisi ve orta hattı birlikte tara; bulunan parankimin kortikal görünümünü, üreterin karşıya dönüşünü ve damar çıkışını normal böbrek anatomisiyle karşılaştır.

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

Renal agenezi: renal fossada veya pelviste renal parankim bulunmaz; ipsilateral renal arter de çoğunlukla gelişmemiştir.
Nefroptoz: böbrek supin ve ayakta pozisyonla yer değiştirir; sabit pelvis yerleşimi ve kısa anomalili damarlar ektopiyi destekler.
Pelvik renal tümör: tümör renal parankim mimarisini bozar; ektopik böbrek normal kortikomedüller yapı ve kendi toplayıcı sistemiyle tanınır.
At nalı böbrek: iki alt pol orta hatta parankimal isthmusla birleşir, ancak iki renal fossada böbrek üniteleri yine bulunur.

Tuzaklar

Boş renal fossa nefrektomi veya ageneziyi tek başına kanıtlamaz; pelvis, iliak damar çevresi ve karşı tarafı sistematik olarak tara.
Çapraz ektopik böbreğin üreteri orta hattı geçerek böbreğin ortotopik taraftaki mesane orifisine açılır; mesane tarafını yalnız böbreğin konumundan çıkarsama.
Anomalili böbrek küçük veya malrotasyonlu olduğu için retroperitoneal lenf nodu/kitle sanılabilir; kortikomedüller yapı, renal sinüs ve toplayıcı sistemi ara.
Tek bir normal çıkışlı renal arter beklemek damar yaralanmasına yol açabilir; özellikle pelvik böbrekte iliak ve distal aortik dalları izleyerek haritala.

Kendini dene

Sol renal fossa boş; sağ pelviste ikinci renal parankim var ve üreteri orta hattı geçerek sola dönüyor. En doğru tanım nedir?
Cevabı göster
Çapraz renal ektopi. Karşı tarafta bulunan böbrek ünitesi ve orta hattı geçerek kendi tarafındaki mesaneye dönen üreter çapraz ektopiyi gösterir. Agenezide parankim yoktur; at nalında iki renal ünite fossalarda durur; nefroptoz pozisyona bağlı aşağı yer değiştirmedir.
Pelvik ektopik böbrekli hastada BT anjiyografide en çok hangi damar varyasyonu beklenir?
Cevabı göster
İliak arterden renal dal. Ektopik böbrek damarlanması distal aorta veya iliak arterlerden gelebilir ve birden fazla kısa arter bulunabilir. Diğer seçeneklerdeki damar eşleşmeleri normal renal arter anatomisini yansıtmaz.

İlgili konular

Kaynaklar

Bu sayfadaki 41 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 10 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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