Böbrek travması

Özet

Böbrek yaralanmalarının en sık nedeni künt travmadır; penetran travma da renal yaralanma mekanizmalarındandır. Hemodinamik olarak stabil hastada renal travmanın değerlendirilmesinde kontrastlı BT temel görüntüleme yöntemidir. İlk incelemede üriner sistem travması şüphesi varsa, idrar kaçağını araştırmak için gecikmiş ekskretuar faz görüntüleme yapılır.

Faz ve pencere

Gecikmiş tanısal

İlk incelemede üriner sistem travması saptanır veya şüphesi oluşursa, idrar kaçağını araştırmak için gecikmiş ekskretuar faz görüntüleme yapılır.

BT bulguları

• Subkapsüler hematom, böbrek kapsülü altında yerleşen ve renal parankime bası oluşturabilen bir kanama koleksiyonudur.
• Perirenal hematom, Gerota fasyası içinde böbreği çevreleyen kan birikimidir.
• Travmatik renal arter trombozu, multiphasik BT ile saptanabilen renal vasküler yaralanmalardandır.
• Multiphasik BT renal arter trombozu ve buna bağlı infarktı saptamaya yardımcı olur; bir olgu bildiriminde renal hilus hasarı hematüri olmadan görülmüştür.

Ölçütler ve sınıflamalar

AAST 2018 derece IV toplayıcı sistem ölçütü

AAST böbrek yaralanmaları beş dereceye ayrılır; derece IV bu sınıflamanın basamaklarından biridir.

AAST Böbrek Organ Yaralanma Ölçeği (2018 güncellemesi)

Derece I, AAST böbrek yaralanma sınıflamasındaki beş dereceden biridir. Derece II, AAST böbrek yaralanma sınıflamasındaki beş dereceden biridir. Derece III, AAST böbrek yaralanma sınıflamasındaki beş dereceden biridir. Derece IV, AAST böbrek yaralanma sınıflamasındaki beş dereceden biridir. Derece V, AAST böbrek yaralanma sınıflamasındaki beş dereceden biridir.

Normalde

Üriner sistem travması ilk BT incelemesinde fark edilirse, idrar kaçağını araştırmak için gecikmiş ekskretuar faz görüntüleme yapın.

Ayırıcı tanı

Renal kist BT'de düzgün sınırlı, sıvı yoğunluklu bir lezyon olarak görülebilir.

Renal tümörlerin BT değerlendirmesinde lezyonun dansite ve kontrastlanma özellikleri incelenir.

Tuzaklar

• Tek portal faz aktif arteriyel odağı ve idrar kaçağını birlikte göstermez; arteriyel kaçak şüphesinde dinamik büyümeyi, derin laserasyonda ekskretuar fazı ara.
• İlk incelemede üriner sistem travması şüphesi varsa, idrar kaçağını belirlemek için gecikmiş ekskretuar faz görüntüleme yapılır.

Kendini dene

1. Yüksek dereceli renal travmada ekskretuar faz gecikmesinin uzaması, başlangıç BT'sinde idrar ekstravazasyonu saptanmasıyla nasıl ilişkilidir?

   • Saptanma olasılığı artar
   • Saptanma olasılığı azalır
   • Saptanma olasılığı değişmez
   • Ekstravazasyon yalnız arteriyel fazda saptanır
   Cevabı göster

   Saptanma olasılığı artar. Çok merkezli çalışmada ekskretuar faza kadar geçen sürenin uzaması, başlangıç BT'sinde idrar ekstravazasyonu saptanmasıyla pozitif ilişkiliydi (dakika başına risk oranı 1,15); saptama için optimal gecikme 9 dakika bulundu.

2. İlk BT incelemesinde üriner sistem travması fark edilirse, idrar kaçağını araştırmak için hangi faz görüntülemesi yapılır?

   • Gecikmiş ekskretuar faz
   • Yalnız kontrastsız faz
   • Yalnız erken arteriyel faz
   • Görüntüleme fazı gerekmez
   Cevabı göster

   Gecikmiş ekskretuar faz. İlk incelemede üriner sistem travması saptanırsa, idrar kaçağını belirlemek için gecikmiş ekskretuar faz görüntüleme yapılır.

İlgili konular

• Travmatik toplayıcı sistem yaralanması ve idrar kaçağı
• Spontan renal/perirenal kanama

Kaynaklar

Bu sayfadaki 29 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 15 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.