Klinik Atölye

Böbrek: diğer hastalıklar · Patoloji · Kritik

Renal infarkt

Renal infarction

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Renal infarkt: yayımlanmış olgu görüntüsü, aksiyel kesit

4 adım

Görüntü: Hellerhoff, “Nierenteilinfarkt rechts 46W - CT axial KM pv”, Wikimedia Commons · CC BY-SA 4.0. Değişiklik: kırpıldı, yeniden boyutlandırıldı, odak işaretleri eklendi.

Özet

Renal infarkt, renal arter veya dallarının emboli, tromboz ya da diseksiyonla tıkanması sonucu böbrek parankiminde gelişen iskemik nekrozdur. Ani yan veya karın ağrısında kontrastlı BT, parankimdeki infarkt alanlarını gösterebilir; renal arterde dolum kusuru da saptanabilir. Renal infarktta BT'de kama biçimli hipoenhans alanlar görülebilir ve bu görünüm tanımayı destekler. Tanı zamanında konmazsa renal infarkt geri dönüşsüz organ hasarına yol açabilir.

Faz ve pencere

BTA tanısal
Kontrastlı BT'de renal arterde dolum kusuru görülebilir; parankimde infarkt alanı kama biçimli hipoenhans odak olarak izlenebilir.
Nefrografik tanısal
Nefrografik fazda kapsüle dayanan, tabanı periferde ve apeksi renal sinüse yönelen hipoenhans kama seçilir; lezyon korteks ile medullayı birlikte tutabilir.

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

BT bulguları

  • Periferik parankim defekti üçgen/kama biçimindedir; tabanı renal kapsüle, tepesi renal sinüse yönelir.
  • Hipoenhans alanın sınırı çoğunlukla keskindir ve tek bir segmental arterin beslenme alanına uyar; belirgin kitle etkisi beklenmez.
  • Besleyici segmental renal arterde trombüs, embolik dolum kusuru veya ani damar sonlanması görülebilir.
  • Ana renal arter tıkanırsa tek böbreğin büyük bölümü kontrastlanmasını kaybedebilir; karşı böbrek normal kalabilir.
  • Kronikleşen odakta parankim incelmesi, kama biçimli hacim kaybı ve böbrek konturunda çekinti gelişebilir.

Normalde

Karşılaştırmalı değerlendirmede renal infarkt alanı BT'de kama biçimli hipodensite olarak görülebilir.

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

Akut piyelonefrit
kama biçimli hipoenhanslık oluşturabilir; çizgisel/çizgili nefrogram, perinefrik inflamasyon ve enfeksiyon bağlamı inflamasyonu destekler, dal oklüzyonu beklenmez.
Fokal bakteriyel nefrit
hipoenhans odak yapabilir; çoğu kez kitle benzeri veya çizgili kontrastlanma bozukluğu gösterir ve renal arter dalında kesilme yoktur.
Akut kortikal nekroz renal korteksin iskemik nekrozudur; lezyonlar fokal, multifokal veya difüz olabilir.
Renal ven trombozunda renal ven lümeninde trombüs ve venöz akım yokluğu saptanabilir; venöz konjesyona rağmen parankim nekrozu, venöz anastomozlar nedeniyle nadirdir.

Tuzaklar

  • Akut piyelonefritte fokal kama biçimli düşük atenüasyon alanları görülebildiğinden renal infarktla ayırıcı tanı gerekir.
  • Kontrastlı BT'de kama biçimli hipodens parankim alanları görülebilir; BT her olguda infarktın özgül nedenini göstermez.
  • Kronik infarktın kontur çekintisi aktif iskemi anlamına gelmez; akut kontrastlanma defekti ve eski hacim kaybını ayrı tarif et.

Kendini dene

  1. Ani yan ağrısı olan hastada kontrastlı BT'de kama biçimli hipoenhans renal parankim alanları ve renal arterde dolum kusuru görülüyor. En olası tanı nedir?

    Cevabı göster

    Renal infarkt. Kama biçimli hipoenhans renal parankim alanları ile renal arterde dolum kusurunun birlikte görülmesi renal infarktla uyumludur.

  2. Taş hastalığı dışlanan ve renal infarkt şüphesi bulunan ani yan ağrılı hastada tanı için hangi görüntüleme yöntemi tercih edilir?

    Cevabı göster

    Kontrastlı abdomen BT. Taş hastalığı dışlandıktan sonra renal infarkt tanısı için kontrastlı BT esastır; ultrasonografinin duyarlılığı daha düşük olduğundan tanıdaki değeri sınırlıdır.

İlgili konular

Kaynaklar

Bu sayfadaki 29 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 4 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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