Klinik Atölye

Kadın genital sistemi · Patoloji · Orta öncelik

Over endometrioması

Ovarian endometrioma

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Over endometrioması: yayımlanmış olgu görüntüsü, aksiyel kesit
Görüntü konuyu kısmen gösteriyor; bulgunun bir bölümü seçilebilir.

4 adım

Görüntü: Miyazaki Y, Takada S, Yamazaki R ve ark., “Ruptured Ovarian Endometrioma During Pregnancy: A Case Report and Review Highlighting Clinically Occult Risk Factors.” 2026, Figure 1. PMC12916156 · doi:10.7759/cureus.101871 · CC BY 4.0. Değişiklik: yeniden boyutlandırıldı.

Özet

Endometrioma, tekrarlayan kanama ve yapışıklıklarla ilişkili olarak çoğunlukla üreme çağındaki hastalarda görülür; pelvik ağrı ve infertilite öyküsü eşlik edebilir. Pelvik endometriozis değerlendirmesinde US ilk basamak görüntüleme yöntemidir; bu nedenle BT endometrioma için primer görüntüleme yöntemi değildir. US ve MRG kist içeriğini ve eşlik eden endometriozisi karakterize etmede daha kullanışlıdır. Endometrioma rüptürü hemoperitoneum ve peritonite yol açabilir; endometriotik kistlerde malign dönüşüm riski de tanımlanmıştır.

Faz ve pencere

Kontrastsız
Kist içeriği basit sıvıdan yüksek atenüasyonda ve görece homojen olabilir; kan ürünleri BT’de nonspesifik yoğunluk artışı gösterir ve MRG’deki T1 hiperintensitesi/T2 gölgelenme bulgularını doğrudan karşılamaz.
Portal
Kontrastlı seride duvar veya papiller çıkıntıdaki gerçek kontrastlanma, varsa kontrastsız seriyle karşılaştırılarak değerlendirilir; BT’de mural nodül karakterizasyonu sınırlıdır.

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

BT bulguları

  • Basit sıvı yoğunluğundan daha yüksek atenüasyonlu, düzgün sınırlı adneksiyel kist
  • Bilateral benzer kistik lezyonlar veya uterus arkasında birbirine yaklaşmış overler
  • Kistin pelvis yan duvarı ya da uterusla geniş temas göstermesi; yapışıklık ve çekintiyi düşündüren sabit konum
  • Douglas boşluğunun silinmesi veya rektosigmoid ile uterus arasında fibrotik yumuşak doku
  • Kist duvarında yeni solid kontrastlanan nodül ya da papiller çıkıntı; endometriozis ilişkili tümör açısından kuşkulu
  • Rüptürde kist çevresinde serbest sıvı, yüksek atenüasyonlu hemoperitoneum ve peritoneal irritasyon bulguları

Normalde

Normal overlerde parankim ve fizyolojik foliküller seçilir; kompleks, yüksek atenüasyonlu kistik boşluk ya da iki overi birbirine çeken fibrotik bant bulunmaz. Aynı pelvis düzeyinde karşı overin konturunu, Douglas boşluğunun açıklığını ve rektosigmoid-uterus arasındaki yağ planını kıyaslayın.

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

Hemorajik fonksiyonel kist
over endometriomadan ayırımında MRI’daki T2 gölgelenme eksikliği ve T2 koyu nokta bulgusunun yokluğu değerlidir; US ile korpus löteüm rüptürü değerlendirilebilir.
Over epitelyal tümörü
kalın septa, papiller çıkıntı veya kontrastlanan solid bileşen malignite kuşkusunu artırır.
Matur kistik teratom
adneksiyel lezyonda yağ-sıvı seviyesi görülmesi teratomu düşündürebilir ve endometriomadan ayırımda yardımcı olabilir.
Tubo-ovaryan apse
tüp-over kompleksinde kalın duvarlı koleksiyon, çevre yağ dokusunda belirgin inflamasyon ve komşu tüp genişlemesi görülür.
Peritoneal inklüzyon kistleri pelvis MRG’sinde görülebilir.

Tuzaklar

  • MRG’de T2 düşük sinyalli kistler yalnızca endometriomaya özgü değildir; hemorajik fonksiyonel kistler de benzer sinyal özelliği gösterebilir.
  • İki overin bitişik durması tek başına kissing ovaries bulgusu değildir; uterus arkası yapışıklığı ve diğer endometriozis odaklarıyla birlikte değerlendir.
  • Kist duvarındaki gerçek kontrastlanan nodül pıhtıdan ayrılmalıdır; karşılaştırılabilir kontrastsız ve kontrastlı seriler yoksa BT karakterizasyonu sınırlıdır.
  • Endometrioma ve derin infiltratif hastalık BT’de küçük veya ince fibrotik lezyonlar halinde görünmeyebilir; negatif BT hastalığı dışlamaz.

Kendini dene

  1. MRG’de tekrarlayan kanamayla ilişkili, T1’de çok sayıda hiperintens kist odağı ve T2 gölgelenme gösteren lezyon için en olası tanı nedir?

    Cevabı göster

    Over endometrioması. Over endometriomalarında tekrarlayan kanama kan içeren kistik boşluklar oluşturabilir; MRG’de T1 hiperintens çoklu odaklar ve T2 gölgelenme tanıyı destekleyen bulgulardır.

  2. Endometrioma ile ilişkili over karsinomunu araştırırken kaynakta en duyarlı MRG bulgusu olarak belirtilen özellik hangisidir?

    Cevabı göster

    Kist içinde yeni kontrastlanan mural nodül. Endometrioma içinde yeni ortaya çıkan kontrastlanan mural nodül, endometriozis ilişkili over karsinomu için kaynakta en duyarlı MRG bulgusu olarak belirtilmiştir; bazı benign lezyonlarda da görülebileceğinden tek başına kesin tanı koydurmaz.

İlgili konular

Kaynaklar

Bu sayfadaki 32 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 2 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.