Abdominal aort anevrizması

Özet

Abdominal aort anevrizması (AAA), infrarenal aortun lokalize genişlemesidir; yaşlı bireylerde sık görülür, çoğu asemptomatiktir ve tarama yapılmayan ortamlarda çoğunlukla tesadüfen saptanır. BT, anevrizmanın gerçek dış çapını, mural trombüsü, renal arterlerle ilişkisini ve iliak uzanımını göstererek anatomik haritalama sağlar. Semptomatik hastada kontrastlı BT anjiyografi rüptür ve tedavi planlaması açısından kritik anatomik bilgiyi verir. Anevrizmanın veya eşlik eden rüptürün atlanması ölümcül kanamanın tanınmasını geciktirebilir.

Faz ve pencere

Kontrastsız

Kontrastsız BT, ultrasonografinin uygun olmadığı hastalarda AAA saptamak için kullanılabilir. Hiperdens duvar/trombüs odağı akut kanama açısından incelenir.

BTA tanısal

Kontrastlı BT anjiyografi anevrizmanın yerini, boyutunu ve uzanımını, dal damarlarla ilişkisini ve anevrizma içindeki trombüsü değerlendirir; işlem öncesi anatomik planlama için kullanılır.

Önerilen pencereler: Batın (G 400 / M 50), Anjiyo (G 600 / M 150).

BT bulguları

• İnfrarenal aorta çapı ≥3 cm olduğunda anevrizmal kabul edilir.
• Aort kıvrımlıysa tek boyut eğri nedeniyle abartılı olabileceğinden, merkez çizgisine dik düzlemde dış duvardan dış duvara ölçüm esastır.
• Patent lümen çevresinde hilal biçimli ya da çevresel kontrastsız mural trombüs bulunabilir; trombüs anevrizma dış sınırına dahil edilerek çap ölçülür.
• BT anjiyografi anevrizma içindeki mural trombüsü değerlendirmeye yardımcı olur.
• BT anjiyografide proksimal ve distal anevrizma sınırlarının dal damarlarla ilişkisi ve damar uzunlukları değerlendirilebilir.
• Anevrizmanın aort bifurkasyonuna, ortak iliak arterlere ve çölyak/SMA/renal arter ostiumlarına uzanımını ayrı ayrı izle.
• Anevrizma kesesinde mural ülser, fokal bombeleşme, çevre hematom veya aktif ekstravazasyon varsa eşlik eden akut komplikasyon düşün.

Ölçütler ve sınıflamalar

Abdominal aort anevrizması çap tanımı

≥3.0 cm

Normalde

Normal infrarenal abdominal aortun ön-arka çapı 2 cm'ye kadar olabilir. Aynı seviyede ölçerken anevrizma dış sınırını ve mural trombüsü dahil et, normal proksimal aort çapıyla ve merkez çizgisine dik kesitle kıyasla; aksiyel kesitte eğik ölçüm yalancı büyüklük oluşturabilir.

Ayırıcı tanı

Aort ektazisi

hafif, düzgün genişleme vardır; anevrizma için kullanılan 3 cm eşiğine ulaşmayabilir.

Aort psödoanevrizması

damar duvarının tüm katmanlarıyla çevrili olmayan fokal kese, travma veya girişim öyküsüyle birlikte görülebilir.

Penetran aterosklerotik ülser

aort duvarındaki fokal bir yırtık olup sakküler genişlemeye ilerleyebilir.

Aort diseksiyonu

genişlemiş tek kese yerine intimal flep ve gerçek-yalancı lümen ayrımı izlenir.

Retroperitoneal kitle

sınırlı rüptüre bağlı hematom retroperitoneal maligniteyi taklit edebilir.

Tuzaklar

• Aort kıvrımlıysa aksiyel kesit gerçek maksimum çapı olduğundan büyük gösterebilir; ölçümü merkez çizgisine dik eğri düzlem rekonstrüksiyonda yenile.
• Çapı yalnızca kontrastla dolan lümenden ölçme; mural trombüsü ayrıca değerlendir, çünkü kontrast kolonu anevrizma çapını doğru göstermeyebilir.
• Aort bifurkasyonuna yakın iki iliak arterin üst üste geldiği kesit, distal anevrizma gibi görünebilir; koronal planda damar devamlılığını izle.
• Küçük sakküler çıkıntı, penetran aterosklerotik ülser gibi fokal bir aort duvarı yırtığıyla ilişkili olabilir.

Kendini dene

1. BT anjiyografide infrarenal aorta dıştan dışa 3,4 cm; lümen çevresinde trombüs görülüyor. En uygun tanım hangisi?

   • Abdominal aort anevrizması
   • Aort diseksiyonu
   • Penetran ülser
   • Aort psödoanevrizması
   Cevabı göster

   Abdominal aort anevrizması. İnfrarenal abdominal aorta çapı ≥3 cm olduğunda anevrizmal kabul edilir; kıvrımlı anevrizmalarda dış ön-arka çap yerine kısa eksen çapı kullanılabilir. BT anjiyografi anevrizmanın yerini, boyutunu ve uzanımını gösterir; ayrıca anevrizma içindeki trombüsü değerlendirebilir.

2. Aort kıvrımlı olduğunda aksiyel kesitte tek bir çap ölçümü eğrilik nedeniyle olduğundan büyük görünebilir. Kıvrımlı aortada anteroposterior çap yerine hangi ölçüm tercih edilebilir?

   • Kısa eksen çapı
   • Aksiyel uzun çap
   • Patent lümen çapı
   • Trombüs kalınlığı
   Cevabı göster

   Kısa eksen çapı. Aort kıvrımlıysa tek boyutlu ölçüm eğrilik nedeniyle olduğundan büyük görünebilir; bu durumda anteroposterior çap yerine kısa eksen çapı kullanılır. BT anjiyografi ayrıca anevrizma içindeki mural trombüsü de değerlendirebilir.

İlgili konular

• Rüptüre abdominal aort anevrizması
• Yaklaşan rüptür düşündüren AAA bulguları
• Abdominal aort diseksiyonu

Kaynaklar

Bu sayfadaki 40 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 20 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.