Splenik arter psödoanevrizması BT bulguları

Özet

Splenik arter psödoanevrizması, pankreatik enzimlerin damar duvarında hasar oluşturması, travma veya iyatrojenik girişimlerle ilişkili gelişebilen; damar lümeniyle iletişim kuran ve çevre dokularla sınırlanan bir hematomdur. BT anjiyografi vasküler anatomiyi ve psödoanevrizmayı değerlendirmeye, aktif kanamanın yerini belirlemeye yardımcı olur; kontrastlı BT ayrıca çevredeki pankreatik koleksiyonları gösterebilir. Psödoanevrizma pankreatik kistik lezyon içinde mural nodülü taklit edebileceğinden, çok fazlı BT ve BT anjiyografi lezyonun vasküler niteliğini değerlendirmeye yardımcı olur. Lezyonun psödokist sanılması veya rüptür kanamasının fark edilmemesi, hızla ağırlaşan hemorajinin gözden kaçmasına yol açabilir.

Faz ve pencere

BTA tanısal: BT anjiyografi splenik arter psödoanevrizmasını ve vasküler anatomiyi değerlendirmeye yardımcı olur; pankreatik nekroz çevresinde aktif kanama varsa kanama odağının yeri araştırılır.
Portal tanısal: Kontrastlı BT, psödokist ve nekroz gibi pankreatik lokal komplikasyonları değerlendirebilir; BT anjiyografi vasküler anatomiyi görüntüleyerek psödoanevrazmanın değerlendirilmesine katkı sağlar.
Kontrastsız: Psödoanevrizmanın vasküler anatomisini değerlendirmek için BT anjiyografi kullanılır.

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

BT bulguları

Arterle devamlı kese — splenik arter veya dalından çıkan, kontrast yoğunluğu arterle eşleşen fokal lümen.
Damar dışına sınırlı kese — kaynak arterle bağlantılı ve arteriyel fazda eşzamanlı dolan, çevre doku veya hematomla sınırlanmış kese psödoanevrizmayı düşündürür; BT duvar katmanlarının histolojik bütünlüğünü doğrudan göstermez.
Psödokist içinde arteriyel odak — pankreatik sıvı koleksiyonu içinde küçük, yuvarlak arteriyel kontrastlanma.
Nekrotizan pankreatitte çevre inflamasyon, komşu arterde enzimatik damar duvarı erozyonuyla ilişkili olabilir.
Aktif kanama — BT anjiyografide kanama odağını belirlemeye yardımcı olan damar dışı kontrast ekstravazasyonudur; psödoanevrizma rüptürü yaşamı tehdit eden kanamaya yol açabilir.
Hematom — pankreas çevresinde, bursa omentalis'ta veya perisplenik alanda yüksek dansiteli akut kan.
Organ lümenine fistül bulgusu — psödoanevrizma komşuluğunda mide ya da pankreatik kanal içinde anormal kan yoğunluğu.

Normalde

Splenik arter psödoanevrizmasında BT anjiyografi vasküler anatomiyi görüntüler; normal arterin pankreas gövdesine göre seyri bu kaynaklarda tanımlanmıyor. BT anjiyografi, splenik arter psödoanevrizmasında vasküler anatomiyi görüntülemeye ve tedavi planlamasına bilgi sağlamaya yardımcı olur.

Normal BT ile kıyasla

Aynı bölgenin, kaynak veri setinde patoloji içermediği belirtilen bir BT incelemesini kesit kesit kaydırın; organ sınırlarını açarak anatomiyi hasta görüntüsüyle karşılaştırın. Küçük rastlantısal bulgular tümüyle dışlanmamıştır.

Kaynak: TotalSegmentator v2.01 veri seti (Wasserthal ve ark., Radiology: Artificial Intelligence 2023), CC BY 4.0, vaka s0541; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Gerçek splenik arter anevrizması: gerçek ve psödoanevrizmalar BT morfolojisinde örtüşebilir; travma, pankreatit, cerrahi/girişim ve çevre kanama ya da inflamasyon bağlamı ayrımı destekler, ancak yalnız görüntü konturu kesin sınıflama sağlamaz.
Pankreatik psödokist, pankreatit zemininde oluşan, iyi tanımlı inflamatuvar duvarı ve minimal ya da hiç nekroz içermeyen sıvı koleksiyonudur; içindeki psödoanevrizma mural nodülü taklit edebilir.
Aktif arteriyel ekstravazasyon: şekilsiz kontrast havuzu fazlar arasında yayılır; sınırlı boyunlu ve arterle bağlantılı kese görünümü yoktur.
Venöz varis: portal venöz fazda portal/splenik venle devamlılık ve venöz kontrastlanma gösterir; arteriyel eşzamanlı dolum beklenmez.
Pankreas kistik neoplazmı: septa, mural nodül veya ana pankreatik kanal ilişkisi olabilir; içindeki nodül arterle aynı fazda opaklaşmaz.

Tuzaklar

Pankreatik psödokist içindeki kontrastlanan odağı mural nodül sanma; arteriyel faz BT ve BT anjiyografiyle psödoanevrizmal kontrastlanma olasılığını değerlendir.
Arteriyel fazda dolmayan tromboze keseyi basit koleksiyon olarak dışlama; kontrastsız yüksek dansite, çevre hematom ve geç faz görüntülerini birlikte incele.
Bir kez çekilen tek fazlı görüntüde kontrast kaçağını psödoanevrizma sanma; kese boynunu ve fazlar boyunca kontrast havuzunun şeklini değerlendir.
Peripankreatik nekrozda psödoanevrizma olasılığını gözden kaçırmayın; çevre pankreatik inflamasyon damar duvarında enzimatik erozyona yol açabilir.

Kendini dene

Pankreatitli hastada psödokist içinde splenik arterle aynı fazda opaklaşan ve arterden boyun alan kese görülüyor. Tanı nedir?
Cevabı göster
Splenik arter psödoanevrizması. Arterle doğrudan devamlılık ve arteriyel eşzamanlı kontrastlanma psödoanevrizmayı gösterir. Basit psödokist sıvı içerir, venöz varis venöz sisteme bağlanır; kistik neoplazmda arteriyel kan havuzu niteliğinde kese beklenmez.
Pankreatik psödoanevrizmanın rüptürü hangi ciddi komplikasyona yol açabilir?
Cevabı göster
Hayatı tehdit eden kanama. Psödoanevrizma rüptürüne bağlı kanama hayatı tehdit edebilir.

İlgili konular

Splenik arter anevrizması

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 14 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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