Spontan renal/perirenal kanama BT bulguları

Özet

Travma olmaksızın böbrek parankimine, kapsül altına veya perirenal alana kanama akut yan ağrısı ve hemodinamik bozulmayla ortaya çıkabilir. Kontrastsız BT kanın dağılımını ve yoğunluğunu gösterir; kontrastlı inceleme aktif kanama odağını ve altta yatan kitleyi arar. En sık ilişkilendirilen renal neoplaziler anjiyomiyolipom ve renal hücreli karsinomdur; hematom tümörü örterek ilk incelemede gizleyebilir. Kanama odağı ile nedeni ayırt edilmezse tümörün tanısı ve kanamanın ilerleyişi gözden kaçabilir.

Faz ve pencere

Kontrastsız tanısal: Spontan renal kanama subkapsüler veya perirenal alanlarda görülebilir; kontrastsız BT'de perirenal hematom yüksek atenüasyonlu olabilir.
Arteriyel tanısal: Aktif kanama, renal anjiyografide kontrast ekstravazasyonu olarak görülebilir; BT anjiyografi renal arter anatomisini değerlendirmeye yardımcı olur.
Nefrografik tanısal: Kontrastlı BT'de kanamanın altında yatan renal kitle araştırılır; büyük hematomlar küçük kitleleri örtebilir.
Gecikmiş: Seçilmiş olgularda kontrastlı incelemede devam eden kanama, kontrast ekstravazasyonu olarak görülebilir.

Önerilen pencereler: Batın (G 400 / M 50), Yumuşak doku (G 400 / M 40), Anjiyo (G 600 / M 150).

BT bulguları

Subkapsüler hematom: böbreği bası altında bırakan, kapsül ile parankim arasında hilal biçimli kan koleksiyonu.
Perirenal hematom: Böbrek çevresindeki kanama retroperitoneuma uzanabilir.
Parankim içi hematom: Böbrek parankimi içinde akut kanamayla uyumlu hiperatenüasyonlu odaklar görülebilir.
Anjiyografide aktif kanama, renal arterin distalinde düzensiz yamalı kontrast ekstravazasyonu olarak görülebilir.
Anjiyomiyolipom lehine makroskopik yağ: Böbrek kitlesinde makroskopik yağ bulunması anjiyomiyolipomla uyumludur.
Böbrek hücreli karsinom olasılığı: Kanama başlangıçta böbrek lezyonunu örtebilir; hematom eşlik eden lezyon görüntülemede şüpheli kalabilir.
Hematomun böbrek parankimine dıştan basısı Page böbreği fizyolojisine yol açabilir ve renal perfüzyonu azaltabilir.

Normalde

Kanama değerlendirmesinde BT, böbrek parankimini ve çevresindeki hematomun böbrek üzerindeki kitle etkisini birlikte gösterebilir. Perirenal hematomun böbrek üzerinde kitle etkisi oluşturup oluşturmadığını değerlendir.

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 s0541; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Travmatik renal hematom: çevre yumuşak doku yaralanması, kırık veya kontüzyon eşlik edebilir; spontan kanamada travma öyküsü yoktur ve kitle odağı araştırılır.
Renal hücreli karsinom: Kanama başlangıçta böbrek lezyonunu örtebilir; hematom eşlik eden lezyon görüntülemede şüpheli kalabilir.
Renal anjiyomiyolipom: Makroskopik yağ içeren böbrek kitlesi anjiyomiyolipomla uyumludur; büyük tümörler spontan kanamayla ortaya çıkabilir.

Tuzaklar

Büyük hematom altta yatan renal tümörün tamamını örtebilir; akut kanama çözüldükten sonra hedefli kontrastlı incelemede kalan solid lezyonu yeniden ara.
Aktif ekstravazasyon ile psödoanevrizmayı karıştırma; psödoanevrizma düzgün sınırlı ve arterle bağlantılı kalır, ekstravazasyon çevre hematoma yayılır.
Büyük hematomlar küçük renal kitleleri örtebilir; akut incelemede altta yatan kitle seçilemeyebilir.
Kan yoğunluğu yaşa ve hematokrite göre değişebilir; tek bir atenüasyon değerine dayanmak yerine dağılımı, fazlar arası değişimi ve kaynak odağı birlikte değerlendir.

Kendini dene

Anjiyomiyolipomun temel doku bileşenlerinden biri hangisidir?
Cevabı göster
Yağ dokusu. Anjiyomiyolipom; dismorfik damarlar, düz kas hücreleri ve yağ dokusundan oluşan benign bir böbrek tümörüdür.
Renal arter anjiyografisinde kontrast ekstravazasyonu görülmesi hangi bulguyu gösterir?
Cevabı göster
Aktif kanama. Renal arter anjiyografisinde kontrast ekstravazasyonu aktif kanama bulgusudur.

İlgili konular

Travmatik toplayıcı sistem yaralanması ve idrar kaçağı

Kaynaklar

Bu sayfadaki 33 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 4 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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