Mezenterik ven trombozu

Özet

Mezenterik ven trombozu, akut karın ağrısının venöz kaynaklı nedenidir ve portal venöz uzanımla birlikte ya da tek başına görülebilir. Portal faz BT, SMV ve dallarındaki trombüsü, venöz konjesyonu ve bağırsak duvarı ödemini değerlendirmede temel incelemedir. Venöz çıkış engeli ans duvarına kanama ve sıvı geçişine, daha ileri durumda iskemiye neden olabilir. Trombozun portal bileşkeye uzanımı veya bağırsak nekrozu gözden kaçarsa hastalık yükü ve komplikasyonlar eksik tanımlanır.

Faz ve pencere

Kontrastsız

Akut trombüs bazen damar lümeninde hiperdens görünür; duvar içi hemoraji, kalsifik kronik trombüs ve kontrast öncesi bağırsak yoğunluğu için karşılaştırma sağlar.

Portal tanısal

SMV veya mezenterik dallarda kontrastlanmayan intraluminal dolum defekti; trombüsün portal ven birleşkesine, splenik vene ya da intrahepatik portal dallara uzanımı gösterilir. Venöz faz tanısal fazdır.

BTA

Eşlik eden SMA oklüzyonu veya arterial iskemi şüphesinde arteriyel dolaşım ve bağırsak duvarı kontrastı değerlendirilir; izole ven trombozunun temel fazı değildir.

Önerilen pencereler: Batın (G 400 / M 50), Karaciğer (G 150 / M 30), Yumuşak doku (G 400 / M 40), Anjiyo (G 600 / M 150).

BT bulguları

• SMV intraluminal dolum defekti — kontrastlanan ven lümeni içindeki düşük dansiteli trombüs parsiyel veya tam oklüzyon yapar.
• Mezenterik ven dallarına uzanım — trombüs kök venlerden ince dallara doğru devam edebilir; devamlılığı çok düzlemli görüntüde izlenir.
• Portomezenterik bileşke tutulumu — portal ven veya splenik ven uzanımı trombüsün yayılım alanını belirler.
• Venöz konjesyon — mezenterik venler genişleyebilir ve kıvrımlı kollateraller gelişebilir.
• Ödemli bağırsak duvarı — submukozal ödem, hedef/halo görünümü ve ans çevresinde mezenterik yağ kirlenmesi oluşabilir.
• Duvar içi hemoraji — kontrastsız kesitlerde duvar yoğunluğunun artması venöz basınç hasarını düşündürebilir.
• Pneumatosis ve portal venöz gaz — eşlik ederse ileri bağırsak iskemisi açısından kaygı vericidir; serbest hava perforasyonu destekler.

Normalde

Normal BT'de SMV lümeni kesintisiz kontrastlanır; dolum defekti, venöz genişleme veya komşu bağırsak duvarı ödemi yoktur. Aynı düzeylerde lümen içindeki kontrast devamlılığını, ven çapını, portal vene uzanımı ve ans duvarındaki ödemi normal venöz anatomiyle karşılaştırın.

Ayırıcı tanı

Arteriyel mezenterik iskemi

SMA içinde dolum defekti veya kesilme ve beslenme alanında duvar hipoenhancementi vardır.

Portal ven trombozu

portal ven ana gövdesinde dolum defekti ön plandadır; SMV tutulumu olmadan da görülebilir.

Bağırsak duvarı ödemi/enterit

duvar kalınlaşması vardır ancak mezenterik venlerde gerçek intraluminal dolum kusuru yoktur.

İnvaziv tümör trombüsü

damar içi yumuşak doku kitlesi komşu kitleyle devamlı olabilir ve kontrastlanma gösterebilir.

Tuzaklar

• Portal birleşkedeki dolum defektinin damar anatomisi içindeki uzanımını multiplanar reformatlarla değerlendirin.
• Küçük mezenterik ven trombüslerini değerlendirmek için 1 mm'nin altında kesit kalınlığı tercih edilir.
• Duvar kalınlaşması venöz tromboz için tipik olsa da tek başına özgül değildir; damar içi defekt ve venöz konjesyonu birlikte arayın.

Kendini dene

1. Portal fazda SMV içinde çevresel kontrastla çevrili düşük dansiteli materyal, kalınlaşmış jejunum ve mezenterik ödem var. Tanı nedir?

   • Mezenterik ven trombozu
   • SMA embolisi
   • NOMI
   • İskemik kolit
   Cevabı göster

   Mezenterik ven trombozu. SMV içindeki gerçek dolum defekti ve venöz konjesyon bağırsak duvarı ödemiyle birlikte mezenterik ven trombozunu destekler. Arteriyel nedenlerde SMA patolojisi; NOMI'de distal vazokonstriksiyon; iskemik kolitte çoğunlukla kolon ağırlıklı bulgu beklenir.

2. Kontrastlı BT'de SMV lümeninde dolum defekti ve çevresinde rim tarzı kontrastlanan venöz duvar görülüyor. En olası açıklama?

   • Kontrast karışım artefaktı
   • SMV trombozu
   • Tümör trombüsü
   • Portal hipertansiyon
   Cevabı göster

   SMV trombozu. Kontrastlı BT'de SMV trombozu, çevresinde rim tarzı kontrastlanan venöz duvar bulunan lümen içi dolum defekti olarak görülebilir. Tromboz devamlı dolum kusuru, tümör trombüsü kitleyle ilişki/kontrastlanma, portal hipertansiyon ise kollateral ve splenomegali gibi bulgular gerektirir.

İlgili konular

• Non-oklüzif mezenterik iskemi
• Akut mezenterik arter trombozu

Kaynaklar

Bu sayfadaki 38 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 6 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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