Splenik arter anevrizması

Özet

Splenik arter anevrizması sıklıkla rastlantısal saptanır; gebelik, portal hipertansiyon ve karaciğer nakli gibi bağlamlarda klinik önemi artar. Arteriyel fazlı BT anjiyografi damarın kıvrımlı seyrini gerçek fokal genişlemeden ayırır, açık kese lümenini ve mural trombüsle birlikte toplam dış çapı gösterir. Rüptür halinde perisplenik veya peritoneal kanama ve aktif ekstravazasyon gelişebilir. Anevrizmanın tromboze kısmı lümen gibi sanılırsa boyut ve duvar ilişkisi eksik değerlendirilerek tehlikeli kanama gözden kaçabilir.

Faz ve pencere

BTA tanısal

Arteriyel BT anjiyografide splenik arter boyunca kese biçimli veya iğsi fokal genişleme, kontrastlanan lümen, eksantrik mural trombüs ve distal dallarla devamlılık değerlendirilir.

Portal tanısal

Portal venöz görüntüler perisplenik hematom, hemoperitoneum ve komşu pankreas ya da dalak parankimiyle ilişkiyi gösterir; anevrizma lümeninin tanımı için arteriyel BTA'yı tamamlar.

Kontrastsız

Duvar kalsifikasyonunu, kesedeki trombüsü ve yüksek dansiteli akut kanı saptayabilir; kontrastlı faz olmadan açık anevrizma lümenini doğrulamaz.

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

BT bulguları

• Sakküler genişleme — splenik arter konturundan dışarı doğru kese biçiminde fokal çıkıntı.
• İğsi genişleme — arterin çevresel genişlemesiyle daha uzun bir segmentte artmış dış çap.
• Mural trombüs — kese içinde kontrastlanmayan duvar yapışık kısım ve eksantrik açık lümen.
• Duvar kalsifikasyonu — anevrizma çevresinde ince veya parçalı kalsifiye duvar çizgisi.
• Arteriyel kontrastlanma — açık kese içindeki kontrast yoğunluğunun komşu splenik arterle benzer olması.
• Rüptür çevresi kanama — perisplenik, bursa omentalis veya peritoneal yüksek dansiteli sıvı/hematom.
• Aktif ekstravazasyon — damar dışına yayılan kontrastın arteriyel ve sonraki fazlarda biçim ya da boyut değiştirmesi.

Ölçütler ve sınıflamalar

Çalışmada kullanılan BT anevrizma tanımı

Komşu normal splenik arter segment çapının en az 1,5 katı.

Normalde

Normal splenik arter çölyak kökten pankreas üst kenarı boyunca kıvrımlı ama kalibre olarak süreklidir; tek bir fokal sakküler çıkıntı veya segmental iğsi genişleme göstermez. Kıvrımlı damarı anevrizmadan ayırırken damar merkez hattını multiplanar izleyin, toplam dış çapı ve duvar boyunca kontur değişimini ölçün; yalnız opak lümeni ölçmek mural trombozu olduğundan küçük gösterir.

Ayırıcı tanı

Splenik arter psödoanevrizması

pankreatit, travma veya girişim çevresindeki düzensiz kese ve çevre inflamasyon damar duvarı yaralanmasını düşündürür.

Splenik arter kıvrımlılığı

birbirine yakın kesitlerde ayrılan kıvrımlı damar segmenti MPR'de devamlı izlenir ve gerçek fokal dış çap artışı göstermez.

Splenik arteriyovenöz fistül

arterle erken dolan geniş splenik ven arasında doğrudan bağlantı ve portal venöz sistemde erken kontrastlanma görülebilir.

Pankreatik psödokist

arterle eşzamanlı kontrastlanan lümen yerine sıvı içerikli koleksiyon izlenir; ancak içine psödoanevrizma kanamış olabilir.

Pankreas kisti splenik arter anevrizmasını taklit edebilir; kontrastsız BT'de ayrım güç olabileceğinden BT anjiyografiyle değerlendirme gerekebilir.

Tuzaklar

• Kıvrımlı splenik arterin aksiyel kesitte yuvarlak görünmesini anevrizma sayma; ardışık kesitlerde ve koronal/oblik MPR'de damarın seyrini izle.
• Mural trombozlu kesede yalnız kontrastlanan lümeni ölçme; anevrizmanın en geniş dış duvar çapını ve açık lümenini ayrı tarif et.
• Pankreatitli hastada kalsifikasyonlu psödokisti basit sıvı koleksiyonu sanma; arteriyel fazda duvarla bağlantılı kontrastlanan kese ara.
• Rüptüre kese çevresindeki aktif kanamayı gözden kaçırma; arteriyel odakla hematom içindeki kontrast havuzunun fazlar arasındaki görünümünü karşılaştır.

Kendini dene

1. Klinik rehberlere ve literatüre göre, genellikle müdahale endikasyonu kabul edilen splenik arter anevrizması çap eşikleri hangisidir?

   • Büyüklük >2-3 cm veya semptomatik olması
   • Büyüklük >10 cm olması
   • Yalnızca rüptür halinde
   • Büyüklük >5 cm olması
   Cevabı göster

   Büyüklük >2-3 cm veya semptomatik olması. Literatürde küçük SAAs (2 cm'ye kadar) asemptomatik takip edilirken, 2-3 cm üzerindeki veya semptomatik gerçek anevrizmaların tedavisi önerilir. Psödoanevrizmalar ise boyuttan bağımsız olarak acil tedavi gerektirir.

2. Splenik arter anevrizmalarının (SAAs) boyutuna göre sınıflandırılmasında 'devasa (giant)' anevrizma tanısı için kullanılan çap eşidi nedir?

   • ≥ 5 cm
   • ≥ 10 cm
   • ≥ 2 cm
   • ≥ 1 cm
   Cevabı göster

   ≥ 5 cm. Literatürde devasa (giant) SAAs ve psödoanevrizmalar, çaplarının ≥ 5 cm olduğu durumlarda tanımlanır ve rüptür riskinin arttığı bu boyutta acil tedavi gerekliliği vurgulanır.

İlgili konular

• Splenik arter psödoanevrizması
• Çölyak arter anevrizması veya diseksiyonu

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 1 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez. İçerik yapay zekâ destekli bir süreçle güncel literatüre göre cümle cümle kaynaklarla karşılaştırıldı, ancak uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.