Pelvik arter yaralanması ve psödoanevrizma

Özet

Pelvik halka kırıkları internal iliak arter ve dallarını gererek, keserek veya kemik kenarına sıkıştırarak yaralayabilir; eksternal iliak sistem de travmadan etkilenebilir. BT anjiyografide ekstravazasyon, damar kesintisi, intimal düzensizlik, psödoanevrizma ve arteriyovenöz fistül doğrudan damar hasarı işaretleridir. Arteriyel seri lezyonun doluşunu, portal seri odağın devam edip yayılmasını ve çevre hematomu ortaya koyar. Psödoanevrizma veya damar kesilmesi gözden kaçarsa gecikmiş kanama, yeniden kanama ya da distal perfüzyon kaybı saptanamayabilir.

Okuma sırası

1. İnternal iliak arter dalları. Arteriyel seride iliak bifurkasyondan internal iliak dala ilerleyin; hematomun kenarında fokal kese ya da damar dışı kontrast odağı arayın.
2. Psödoanevrizma kesesi. Kese varsa çevresini takip edip bir boyunla arter dalına bağlanıp bağlanmadığını gösterin; düzgün sınırlı kese psödoanevrizma lehinedir.
3. Yaralı arter lümeni. Damar lümenini odağın proksimalinde ve distalinde izleyin; ani kesilme, daralma veya çizgisel dolum defekti mural yaralanma işaretidir.
4. Fazlar arası kese, hematom ve komşu kırık. Portal seride kese ve çevre hematomu yeniden inceleyin; büyüyen kaçak, erken dolan ven ve aynı dal yanındaki kemik kırığını eşlikçi bulgu olarak ekleyin.

Faz ve pencere

Arteriyel tanısal

İnternal iliak dallarda arterle aynı anda kontrastlanan, iyi sınırlı fokal kese psödoanevrizmayı; damar dışına çıkan ve arteriyel fazda arter lümeniyle benzer yoğunlukta kontrast ekstravazasyonu aktif arteriyel kanamayı düşündürür. Travmatik arter yaralanmasında lümen içi dolum defekti tromboz veya diseksiyonla ilişkili olabilir. Arteriyel fazda erken venöz opasifikasyon arteriyovenöz fistül lehinedir.

Portal tanısal

Pelvik BT anjiyografide psödoanevrizma ve aktif kontrast ekstravazasyonu ayrı damar yaralanması bulguları olarak saptanabilir. Fazlar arası karşılaştırma bu iki görünümün ayrımına yardımcı olur; hipotansiyon veya zamanlama nedeniyle arteriyel faz negatif olabilir.

BT bulguları

• Psödoanevrizma — arter dalı ile boyun ilişkisi seçilebilen, arteriyel fazda lümenle benzer yoğunlukta fokal kese.
• Aktif arteriyel ekstravazasyon — damar sınırının dışına çıkan ve çevre yumuşak dokuya yayılan kontrast.
• Damar kesilmesi — arter dalında ani sonlanma veya distalde opaklaşmanın kaybı.
• İntimal düzensizlik — fokal daralma, kontur çentiklenmesi veya lümen içi lineer dolum defekti.
• Arteriyovenöz fistül — arteriyel fazda komşu venin beklenenden erken kontrastlanması.
• Besleyici dal-kırık ilişkisi — obturator arter, lateral sakral, superior/inferior gluteal veya internal pudendal dalın kırık çevresi hematomla ilişkisi.
• Eşlik eden hematom — damar yaralanmasının yönünü ve kompartımanlara yayılımını gösteren perivasküler kan.
• Çok fazlı BT'de yavaş aktif kontrast ekstravazasyonları arteriyel ve gecikmiş fazlar arasında minimal değişiklik gösterirken, hızlı ekstravazasyonlara psödoanevrizma eşlik edebilir.

Normalde

Arteriyel fazda erken venöz opasifikasyon arteriyovenöz fistül lehine bir bulgudur. Yaralı tarafı karşı tarafın damar dallanmasıyla ve portal serideki aynı damar/kontrast odağıyla karşılaştırın.

Ayırıcı tanı

Pelvik BT anjiyografide aktif kontrast ekstravazasyonu, psödoanevrizmadan ayrı bir damar yaralanması bulgusu olarak saptanabilir.

Normal arter dalı

beklenen anatomik güzergâhta ilerler ve çok düzlemde ana damar lümeniyle devamlılık gösterir.

Pelvik ven

portal fazda kontrastlanıp venöz yapılarla birleşir; arteriyel fazda aynı yoğunlukta beklenmez.

Tuzaklar

• Psödoanevrizmayı aktif kaçakla eşitlemeyin; kese sınırları içinde kalabilirken aktif ekstravazasyon yumuşak dokuya yayılır.
• Erken ven dolumunu yalnız hızlı dolaşım diye geçmeyin; arteriyel seride komşu ven ve olası fistül bağlantısını izleyin.
• Pelvik arter varyasyonları besleyici dalı beklenen yerde göstermeyebilir; hematom merkezinden geriye doğru dalları takip edin.
• Kontrast odağı kemik fragmanına komşu olduğunda kemik penceresi ve kontrastsız seriyle kontrol edin; kalsifikasyon fazlar arasında biçimini değiştirmez.
• Arteriyel fazda psödoanevrizmanın görülmemesi onu dışlamaz; bir olguda kanama sırasında kontrastlı BT'de belirginleşmeyen psödoanevrizma anjiyografide saptanmıştır.

Kendini dene

1. Arter duvarı rüptürü sonrası arter çevresinde oluşan ve tam arter duvarı bulunmayan lezyon nasıl adlandırılır?

   • Psödoanevrizma
   • Venöz varis
   • Flebolit
   • Arteriyovenöz fistül
   Cevabı göster

   Psödoanevrizma. Psödoanevrizma, arter duvarı rüptüründen sonra arter çevresinde oluşan ve tam arter duvarı bulunmayan bir hematomdur.

2. Arteriyel fazda aynı taraftaki internal iliak arterle birlikte komşu ven de erkenden opaklaşıyor. Hangi damar yaralanması düşünülür?

   • Arteriyovenöz fistül
   • Arter diseksiyonu
   • Psödoanevrizma
   • Venöz tromboz
   Cevabı göster

   Arteriyovenöz fistül. Arteriyel fazda erken venöz kontrastlanma arter ile ven arasında fistül bağlantısını düşündürür. Travmatik vasküler yaralanma bulguları arasında intimal flap, diseksiyon, psödoanevrizma ve arteriyovenöz fistül yer alır.

İlgili konular

• Pelvik travmada aktif kanama
• Pelvik retroperitoneal hematom
• Pelvik venöz kanama örüntüsü

Kaynaklar

Bu sayfadaki 38 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.