Kalsifiye psoas tüberküloz apsesi

Özet

Kalsifiye psoas tüberküloz apsesi, çoğunlukla omurga tüberkülozundan psoas kompartımanına uzanan kronik enfeksiyonun kitle benzeri koleksiyonudur. Kontrastsız BT, psoas apsesiyle birlikte vertebra korpuslarında destrüksiyon ve kalsifikasyonu gösterir. Kalsifiye paravertebral veya psoas apsesi ve eşlik eden vertebra destrüksiyonu tüberkülozu güçlü biçimde düşündürür; kesin etken tanısı mikrobiyolojik veya histopatolojik incelemeyle doğrulanır. Spinal tüberkülozla ilişkili psoas apsesinde vertebral destrüksiyona paravertebral ve epidural uzanım eşlik edebilir; bu alanların değerlendirilmesi hastalığın yayılımını ortaya koymaya yardımcı olur.

Faz ve pencere

Kontrastsız tanısal

BT'de psoas apsesi içindeki kalsifikasyonlar ve eşlik eden vertebra destrüksiyonu görülebilir. Kalsifikasyonun yerini ve kemik korteksiyle ilişkisini bu fazda ayırt edin.

Portal tanısal

BT'de psoas koleksiyonu ve eşlik eden vertebra destrüksiyonu değerlendirilebilir.

BT bulguları

• Psoas kasında büyük bir koleksiyon görülebilir.
• Duvar veya içerik kalsifikasyonu — koleksiyon çevresinde çizgisel/duvar biçimli ya da içerikte odaksal mineral yoğunluklar izlenir; kronik tüberküloz odağını destekler.
• Psoas apsesi, psoas kası içinde irin birikmesiyle oluşan bir koleksiyondur.
• Psoas koleksiyonu vertebra ve paravertebral dokularla birlikte tutulabilir; spinal tüberküloz olgusunda epidural uzanım da eşlik etmiştir.
• Psoas apsesine vertebra destrüksiyonu eşlik edebilir.
• Spinal tüberkülozda spondilodiskit görülebilir; bazı olgularda buna prevertebral veya psoas koleksiyonu eşlik eder.
• MRG, epidural ve paravertebral yumuşak doku komplikasyonlarını daha iyi gösterirken BT, sekestr ve paravertebral kalsifikasyon gibi kemik ve kalsifikasyon ayrıntılarını ortaya koyabilir.

Normalde

Psoas apsesi, psoas kası içinde irin birikmesiyle oluşan bir koleksiyondur.

Ayırıcı tanı

Tüberküloz spondilodiskitinde torakal veya çok seviyeli tutulum ve görece korunmuş disk aralığı görülebilir; piyojenik spondilodiskitte erken disk-son plak yıkımı daha çok destekleyici özelliklerdendir.

Psoas hematomu, spinal tüberkülozu taklit edebilen ayırıcı tanılar arasında bildirilmiştir.

Paraspinal kitleler paraspinal yumuşak dokulardan veya vertebral kolondan kaynaklanabilir; bu bölgede primer ve sekonder tümörler de görülür.

Abdominal tüberkülozda pankreas tutulumu ile birlikte kalsifiye lenfadenopati görülebilir.

Kalsifikasyon tek başına tüberküloz etkenini kanıtlamaz; spinal tüberküloz ile piyojenik spondilodiskit ayrımında tek bir görüntüleme bulgusu tanı koydurucu değildir.

Tuzaklar

• Kalsifikasyon tek başına tüberkülozu mikrobiyolojik olarak kanıtlamaz; raporda görüntüleme örüntüsünü güçlü şüphe olarak tanımlayın ve etken doğrulamasını görüntüden ayırın.
• Kitlelerin kökeni (kas içi, nodal veya vertebral) paraspinal bölgenin anatomik düzenine bağlıdır; doğru konumlandırma lenf nodu, tümör veya apse gibi ayırıcı tanıları birbirinden ayırmada kritik rol oynar.
• Vertebral kemik erozyonu kontrastsız yumuşak doku penceresinde silik kalabilir; aynı alanı kemik algoritmasında ve çok düzlemli kesitlerde inceleyin.

Kendini dene

1. Kalsifiye psoas apsesi ve spondilit saptanan olgu raporunda tüberküloz etkeni nasıl tanımlandı?

   • Psoas apsesine BT eşliğinde perkütan drenaj uygulandıktan sonra Mycobacterium tuberculosis saptandı
   • Kan kültüründe piyojenik bakteri üredi
   • MRG'de görülen epidural yayılımla tüberküloz kesinleştirildi
   • Psoas apsesinin kalsifikasyonu tek başına etkeni kanıtladı
   Cevabı göster

   Psoas apsesine BT eşliğinde perkütan drenaj uygulandıktan sonra Mycobacterium tuberculosis saptandı. BT'de kalsifikasyonlu psoas apsesi görüldü; MTB, BT eşliğinde perkütan drenaj sonrası tanımlandı.

2. Olgu raporunda tedavi edilmemiş Pott hastalığına hangi görüntüleme bulguları eşlik ediyordu?

   • Bilateral kalsifiye psoas apseleri ve kifoz
   • Tek taraflı psoas apsesi ve vertebra sklerozu
   • Psoas apsesi olmadan vertebra destrüksiyonu
   • Paraspinal kitle ve disk aralığında genişleme
   Cevabı göster

   Bilateral kalsifiye psoas apseleri ve kifoz. Olgu raporunda tedavi edilmemiş Pott omurgasıyla birlikte bilateral kalsifiye psoas apseleri ve kifoz bildirilmiştir.

İlgili konular

• İliopsoas apsesi
• İliopsoas hematomu

Kaynaklar

Bu sayfadaki 33 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 17 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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