Over ven trombozu ve septik pelvik tromboflebit

Özet

Over ven trombozu en çok doğum sonrası dönemde, ateş ve alt karın ya da yan ağrısıyla başvuran hastada düşünülür; pelvik enfeksiyon, cerrahi ve malignite de zemin hazırlayabilir. Kontrastlı batın-pelvis BT, beklenen retroperitoneal seyirde genişlemiş veni, lümendeki trombüsü ve komşu inflamasyonu göstererek tanıyı destekler; koronal rekonstrüksiyon trombüsün renal ven veya vena kavaya ilerleyişini izlemeyi kolaylaştırır. BT'de perivasküler inflamatuvar değişiklikler, uterusta sıvı ve eşlik eden pelvik tromboflebitle ilişkili olabileceği düşünülen parauterin kitle görülebilir. Trombüs uzanımı ve olası pulmoner emboli gözden kaçarsa ciddi venöz tromboembolik komplikasyon tanınmayabilir.

Faz ve pencere

Portal tanısal

İntravenöz kontrast sonrası over veni, adneks düzeyinden renal venlere doğru izlenir; tromboze segment genişlemiş tübüler damar içinde kontrastlanmayan santral düşük atenüasyonlu dolum defekti ve çevresel duvar kontrastlanması şeklindedir. Perivasküler yağ dokusu kirlenmesi ve eşlik eden pelvik enfeksiyon odakları aynı seride araştırılır.

BT bulguları

• Adneksiyel venöz pleksustan kraniyale, psoas önünden renal hilusa uzanan genişlemiş tübüler over veni.
• Kontrastlı lümen içinde santral hipodens trombüs ve çevresinde ince ya da belirgin duvar kontrastlanması.
• Ven boyunca uzanan perivasküler yağlı doku dansite artışı; enfeksiyon eşlik ediyorsa tromboflebit lehine.
• Sağ over veni tutulumu sık görülür; sol venin renal vene, sağ venin vena kavaya drene olduğu anatomiyi takip et.
• Trombüsün renal vene veya inferior vena kavaya devam etmesi, yalnız pelvik kesitlerle sınırlı kalmayan kraniyal uzanımı gösterir.
• Endometrit, uterin kavitede sıvı, pelvik apse ya da parauterin inflamatuvar kitle gibi eşlik eden enfeksiyon bulguları.
• Over ven trombozunda pulmoner emboli ciddi bir komplikasyondur; klinik şüphede PE’yi değerlendiren kesitsel görüntüleme yapılmalıdır.

Normalde

Normal incelemede karşı over veni normal kalibrasyondadır. Aynı düzeyde sağ veni vena kava inferiora, sol veni sol renal vene kadar kesintisiz izle; şüpheli damarı karşı tarafla ve komşu renal ven/VCI lümenleriyle kıyasla.

Ayırıcı tanı

Endometrit

genişlemiş veya sıvı içeren uterin kavite ve uterin duvar değişiklikleri ön plandadır; tübüler venöz dolum defekti yoktur.

Tubo-ovaryan apse, over ven trombozunun klinik ayırıcı tanılarından biridir.

Üreter taşı/pyelonefrit

üreter boyunca kalkül ve obstrüksiyon ya da böbrek parankimindeki nefrogram asimetrisi tanıyı yönlendirir.

Normal postpartum venöz genişleme

ven kalibresi artabilir; trombüs lehine santral kontrastlanmayan lümen ve çevresel inflamasyon bulunmaz.

Tuzaklar

• Venin oblik seyri tek aksiyel kesitte yuvarlak kitle izlenimi verebilir; koronal planda adneksten renal vene/VCI'ye uzanan damar sürekliliğini izle.
• Multiplanar rekonstrüksiyonlar trombüsün uzanımını izlemeyi kolaylaştırır; tek aksiyal kesitte görülen bulgular komşu kesitlerde doğrulanmalıdır.
• Klinik şüphe devam ederken büyük over veni trombozunun bulunmaması, eşlik eden endometrit veya parauterin enfeksiyon odaklarını dışlamaz.
• Doğum sonrası genişlemiş uterin venler tek başına tromboz değildir; lümenin kontrastla dolup dolmadığına ve damar çevresindeki yağ planına bak.
• Over ven trombozu asemptomatik olarak da görülebilir; görüntüde trombüs saptanması tek başına trombüsün septik olduğunu göstermez.

Kendini dene

1. Doğumdan sonraki ilk haftada ateş ve sağ yan ağrısı olan hastanın kontrastlı BT'sinde adneksten VCI'ye uzanan geniş tübüler damarda santral dolum kusuru görülüyor. En olası tanı nedir?

   • Over ven trombozu
   • Üreter taşı
   • Tubo-ovaryan apse
   • Renal ven anevrizması
   Cevabı göster

   Over ven trombozu. Genişlemiş over veninin beklenen seyri içindeki santral dolum defekti trombozu destekler. Üreter taşı kalkül/obstrüksiyon yapar; apse kompleks adneksiyel koleksiyondur; anevrizmada lümen trombüsü olsa da damar fokal genişler ve venin olağan tübüler hattını izlemez.

2. Over veni trombozu olan hastada koronal planda trombüsün kraniyal uzanımı değerlendirilirken hangi yapılar özellikle izlenmelidir?

   • Renal venler ve inferior vena kava
   • Üreter ve mesane
   • İnfundibulopelvik ligament ve uterin kavite
   • Apendiks ve çekum
   Cevabı göster

   Renal venler ve inferior vena kava. Over veni solda sol renal vene, sağda inferior vena kavaya drene olur. Trombüsün bu merkezi venlere uzanıp uzanmadığı ve ulaştığı en üst düzey görüntüde doğrudan izlenerek raporlanmalıdır; yalnız renal vene uzanım VCI trombozunu kanıtlamaz.

İlgili konular

• Postpartum pelvik komplikasyonlar ve normal postpartum görünüm
• Pelvik venöz konjesyon ve varisler

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 8 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.