Mesane endometriozisi

Özet

Mesane endometriozisi çoğunlukla üreme çağındaki, pelvik ağrı veya döngüsel işeme yakınmaları olan kişilerde mesane serozası ve detrusorunu tutan derin endometriozis biçimidir. Rutin BT tanı için duyarlı ya da özgül değildir; başka nedenle çekilen pelvik BT’de kubbe veya arka duvarda dıştan içe uzanan fokal plak ve komşu pelvik endometriozis bulgularını fark ettirebilir. Detrusor invazyonunun ve küçük kanamalı odakların haritalanmasında hedefli ultrason ve pelvik MR daha elverişlidir. Dıştan kaynaklanan plağın ürotelyal tümör sanılması veya BT’nin normal olmasının hastalığı dışladığının düşünülmesi tanıyı geciktirebilir.

Faz ve pencere

Portal

Kontrastlı rutin pelvis BT'sinde mesane kubbesi ya da arka duvarda serozadan detrusora uzanabilen yumuşak doku plağı, çevre yağ planında çekinti ve eşlik eden pelvik implantlar görülebilir; kan ürünlerinin BT dansitesi özgül değildir ve görünüm hastalığı doğrulamaz.

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

BT bulguları

• Mesane kubbesi veya arka duvarında serozal yüzeyden başlayan fokal, düzensiz yumuşak doku kalınlaşması
• Plak benzeri odağın detrusor boyunca ilerleyip mesane lümenine sınırlı kabarıklık yapması
• Mesane ile uterus ön yüzü arasında yağ planı silinmesi veya yapışıklık izlenimi veren açılanma
• Mesane endometriozisine anterior derin endometriozise bağlı adezyonlar eşlik edebilir.
• Mesane komşuluğunda eşlik edebilen endometrioma kuşkulu adneksiyal kist; içeriği BT ile doğrulanamaz
• Tekrarlayan kanama odağında MR’da yağ baskılı T1 hiperintens odaklar görülebilir; bu odaklar kanamayı düşündürür.
• Mesane duvarı tutulumu kuşkusunda distal üreterleri ve üst üriner sistemi de inceleyin; eşlik eden üreteral endometriozis hidroureteronefroza yol açabilir.

Normalde

Mesane duvarı lezyonunda serozadan mukozaya uzanım yönünü ve duvar tutulumunu değerlendir; BT ve ultrason bulguları mesane endometriozisini maligniteden güvenilir biçimde ayıramayabilir.

Ayırıcı tanı

Ürotelyal karsinom

çoğunlukla lümene uzanan papiller veya asimetrik duvar kitlesi yapar; sistoskopi ve doku örneği ayrım sağlar.

Mesane leiomyomu submukozadan kaynaklanan nadir bir tümördür ve mesanede kitle olarak görülebilir.

Urakal karsinom, mesane kubbesinden umbilikusa uzanan urakal hat boyunca gelişebilir.

Uterin leiomyom mesane endometriozisiyle birlikte bulunabilir.

Fokal sistit, mesane endometriozisi için ayırıcı tanıda düşünülmesi gereken durumlardandır.

Tuzaklar

• BT'de kan ürünü görülmemesi endometriozisi dışlamaz; kanama içeriğini değerlendirmede MR'ın yağ baskılı T1 sekansları daha duyarlıdır.
• Mesane kubbesindeki serozal urakal bant da orta hatta nodüler görünerek benzer yerleşim taklidi yapabilir; sagital planda umbilikusa uzanımı ve serozal sınırlılığı ara.
• Ürotelyal tümör çoğunlukla iç yüz konturunu bozar; endometriozis odağında dış yüz ve komşu pelvik yapılara uzanım ön planda olabilir, ancak BT ile güvenilir ayrım her zaman yapılamaz.

Kendini dene

1. Döngüsel işeme ağrısı olan hastada BT, mesane arka duvarı/kubbesinde dıştan gelişen plak ve uterusla çekinti gösteriyor. En uygun yorum hangisidir?

   • Mesane endometriozisi olası
   • Papiller ürotelyal tümör
   • İntramural leiomyom
   • Akut sistit
   Cevabı göster

   Mesane endometriozisi olası. Dış yüz ağırlıklı plak ve vesikouterin çekinti, klinik bağlamla birlikte derin endometriozisi düşündürür; rutin BT kesin tanı koydurmaz. Mesane endometriozisi ürotelyal maligniteyi taklit edebilir; BT'de görülen duvar kalınlaşması veya yumuşak doku lezyonu güvenilir ayrım sağlamayabileceğinden histopatolojik doğrulama gerekebilir.

2. Rutin BT'de kanamalı odak seçilmemiş ve mesane duvarı kuşkulu. Derin mesane endometriozisini haritalamada hangi yöntem daha uygundur?

   • Hedefli pelvik MR
   • Kontrastsız kafa BT
   • Toraks BT anjiyografi
   • Sadece düz karın grafisi
   Cevabı göster

   Hedefli pelvik MR. Pelvik MR, duvar katmanlarını, kan ürünlerini ve endometriozisin diğer pelvik odaklarını değerlendirmeye yardım eder; hedefli transvajinal ultrason da deneyimli ellerde yararlıdır. Diğer seçenekler pelvik yumuşak dokuyu karakterize etmez.

İlgili konular

• Mesane ürotelyal karsinomu
• İntraperitoneal mesane rüptürü
• Ekstraperitoneal mesane rüptürü
• BT sistografi ve mesane dolum tekniği

Kaynaklar

Bu sayfadaki 34 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 4 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.