Akut alt ekstremite iskemisi

Özet

Akut alt ekstremite iskemisi, ani arteriyel perfüzyon azalmasının ekstremiteyi tehdit ettiği klinik acildir; emboli, plak üstü tromboz, greft/stent kapanması veya popliteal anevrizma trombozu neden olabilir. BTA, hızlı anatomik haritalama gerektiğinde tıkanmanın yerini, uzunluğunu, distal yeniden doluşu ve korunmuş runoff damarlarını gösterir; klinik muayene ve Doppler değerlendirmesinin yerini almaz ve görüntüleme acil girişimi geciktirmemelidir. Akut kapanma zemini kronik aterosklerozla birleşebileceği için ani tıkanma ile önceden var olan çok seviyeli hastalık ayrı ayrı tarif edilmelidir. Distal tibial damarların ve popliteal anevrizmanın atlanması ekstremiteyi tehdit eden yaygın tromboemboliyi ve gerçek distal akım yatağını yanlış değerlendirebilir.

Faz ve pencere

BTA tanısal

Arteriyel kontrast kolonunda ani segmental kesilme, intraluminal dolum defekti, proksimal plak veya greft/stent zemini, distal kollateral yeniden doluş ve tibial runoff araştırılır.

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

BT bulguları

• Ani arteriyel kesilme — kontrastla dolu lümenin belirli bir seviyede keskin sonlanması ve aşağıda opasifikasyonun kaybolması.
• İntraluminal trombüs — kontrast kolonu içinde çevresi kontrastla sınırlı dolum defekti veya lümeni tamamen dolduran hipodens materyal.
• Embolik yerleşim — bifurkasyon ya da dallanma ağzında keskin sonlanma; tıkanmanın çevresindeki damarda belirgin yaygın plak bulunmaması emboliyi destekler.
• Yerinde tromboz zemini — kapanma öncesi yaygın aterom, uzun darlık, stent veya bypass greftinde lümen kaybı.
• Distal yeniden doluş — tıkalı segment sonrasında kollateral damarlarla tekrar opaklaşan popliteal veya tibial arter.
• Çok seviyeli distal embolizasyon — birden fazla tibial arterde ayrı ani dolum kesintileri ve zayıf ayak runoff'u.
• İskelet kası perfüzyon azalması — arteriyel fazda ilgili kompartımanlarda karşı bacağa göre belirgin az kontrastlanma; tek başına canlılık sınıflaması değildir.

Ölçütler ve sınıflamalar

Akut ekstremite iskemisi zaman tanımı

Belirti süresi <2 hafta

Rutherford akut ekstremite iskemisi sınıflaması

Akut ekstremite iskemisinin şiddeti ve geri dönüşsüzlük derecesi Rutherford sınıflaması ile belirlenir. Klinik ve Doppler temelli sınıflamadır; BT tek başına kategori koydurmaz.

Normalde

Normal karşı taraf BTA'sında ortak femoralden popliteal ve tibial arterlere uzanan opak lümen kesintisizdir; kas kompartımanları benzer arteriyel kontrastlanma gösterir. İskemik tarafı aynı seviyedeki karşı damar çapı ve opasifikasyonuyla kıyaslayın, kapanmanın proksimal sınırını ve distal yeniden doluşu izleyin; karşı ekstremite de kronik PAH taşıyabileceğinden onu mutlak normal kabul etmeyin.

Ayırıcı tanı

Kronik periferik arter hastalığında aterosklerotik popliteal ve tibial arter tutulumu ile distal yeniden doluş görülebilir.

Aort diseksiyonu

intimal flep ve gerçek lümen basısı iliak akımı azaltabilir; yalnız ekstremite arterinde embolik kesilme görünümü beklenmez.

Popliteal anevrizma trombozu

popliteal arter dış çapı genişlemiş ve mural trombüsle doludur; izole embolik femoral kapanma ile karıştırılmamalıdır.

Derin ven trombozu

venöz genişleme ve dolum kusuru venöz fazda izlenir; arteriyel lümen kesilmesini açıklamaz.

Düşük debi veya kontrast zamanlama hatası

iki taraflı distal arterlerin zayıf opasifikasyonu gerçek tek taraflı oklüzyon gibi görünmemelidir.

Tuzaklar

• BT anjiyografi yorumunda artefaktların anormallikleri maskeleyebileceği göz önünde bulundurulmalıdır.
• Kasların zayıf kontrastlanması iskemiyi destekleyebilir ama ekstremite canlılığını tek başına belirlemez; klinik duyu, motor muayene ve Doppler bulguları esastır.

Kendini dene

1. Aortoiliak bifurkasyona yerleşen bir emboli hangi bulguya yol açabilir?

   • İki alt ekstremitede arteriyel oklüzyon
   • İzole derin ven trombozu
   • Popliteal arter anevrizması
   • Aort diseksiyonunda gerçek lümen basısı
   Cevabı göster

   İki alt ekstremitede arteriyel oklüzyon. Aortoiliak bifurkasyona yerleşen emboli iki alt ekstremitede arteriyel oklüzyona yol açabilir.

2. BT anjiyografide popliteal arterde anevrizmatik genişleme ve mural trombüs görülüyor. Bu bulgular hangi lezyonla uyumludur?

   • Mural trombüs içeren popliteal arter anevrizması
   • İzole femoral arter embolisi
   • Aort diseksiyonu
   • Baker kisti
   Cevabı göster

   Mural trombüs içeren popliteal arter anevrizması. Popliteal arter anevrizması mural trombüs içerebilir; böyle bir anevrizmanın distal embolizasyona yol açtığı da bildirilmiştir.

İlgili konular

• Alt ekstremite periferik arter hastalığı BTA
• Akut emboli ve akut tromboz ayrımı
• Popliteal anevrizma trombozu ve distal embolizasyon

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 3 cümle bu karşılaştırmada düzeltildi (2026-10-09).

1. Calpain inhibition as a novel therapeutic strategy for aortic dissection with acute lower extremity ischemiapmc.ncbi.nlm.nih.gov
2. Multiple Arterial Thrombosis after COVID-19: A Case Reportpmc.ncbi.nlm.nih.gov
3. Persistent sciatic artery in a patient with unilateral acute lower extremity ischemiapmc.ncbi.nlm.nih.gov
4. Acute Lower-Extremity Ischemia in a Patient with COVID-19pmc.ncbi.nlm.nih.gov
5. Aortic remodeling and competitive flow after surgical treatment of aortic dissectionpmc.ncbi.nlm.nih.gov
6. Clinical Characteristics of Acute Lower Extremity Ischemia Due to Left Atrial Myxoma: A Rare Case Report with Review of Literature.pubmed.ncbi.nlm.nih.gov
7. Quantitative photoacoustic imaging for early detection of muscle ischemia injury.pubmed.ncbi.nlm.nih.gov
8. Acute Lower-Extremity Ischemia in a Patient with COVID-19.pubmed.ncbi.nlm.nih.gov
9. Outcomes and role of peripheral revascularization in type A aortic dissection presenting with acute lower extremity ischemia.pubmed.ncbi.nlm.nih.gov
10. Total Occlusion of Abdominal Aortic Endograft Successfully Treated with Axillobifemoral Bypass.pubmed.ncbi.nlm.nih.gov
11. Complicated retroperitoneal diverticulitis presenting with abscess and acute limb ischemia.pubmed.ncbi.nlm.nih.gov
12. COVID-19-related Peripheral Arterial Thrombosis Treated in a Large Health Maintenance Organization.pubmed.ncbi.nlm.nih.gov
13. Persistent sciatic artery in a patient with unilateral acute lower extremity ischemia.pubmed.ncbi.nlm.nih.gov
14. Progressive Acute Lower Extremity Ischemia Resulting From Cardiac Myxoma Embolization: A Case Report.pubmed.ncbi.nlm.nih.gov
15. Unilateral acute lower extremity ischemia with popliteal artery aneurysm as a result of vascular type III entrapment in an elderly patient.pubmed.ncbi.nlm.nih.gov
16. Contraindications to tissue plasminogen activator thrombolysis for acute lower extremity ischemia.pubmed.ncbi.nlm.nih.gov
17. The effectiveness of percutaneous mechanical thrombectomy in the treatment of acute thromboembolic occlusions of lower extremity.pubmed.ncbi.nlm.nih.gov
18. [Atrial myxom is a rare cause of peripheral embolus].pubmed.ncbi.nlm.nih.gov
19. Multisystem Thromboembolic Shower in the Intensive Care Unit: Acute Limb Ischemia and Mesenteric Embolism.pubmed.ncbi.nlm.nih.gov
20. Acute Bilateral Lower Limb Ischemia in a Middle-Aged Woman: Don't Let the Obvious Distract You From the Occult.pubmed.ncbi.nlm.nih.gov
21. Superficial femoral artery thrombosis after PFNA in an intertrochanteric fracture patient with sarcopenia and copd: a rare case report.pubmed.ncbi.nlm.nih.gov
22. Case Report: Life-saving external hemipelvectomy after missed external iliac artery occlusion in severe pelvic trauma.pubmed.ncbi.nlm.nih.gov
23. "Severe Aortic Regurgitation as the Initial Manifestation of Takayasu Arteritis in a Young Woman: A Case Report".pubmed.ncbi.nlm.nih.gov
24. Acute aortic dissection presenting as crossed neurological symptoms: a case report.pubmed.ncbi.nlm.nih.gov
25. Robotic-Assisted Navigational Bronchoscopy Complicated by Systemic Air Embolism.pubmed.ncbi.nlm.nih.gov
26. When Nausea and Vomiting Are Something Else Entirely, It's Not Gastroparesis: A Report of Two Cases.pubmed.ncbi.nlm.nih.gov
27. Acute Paraplegia in the Emergency Department: Acute Leriche Syndrome as a Vascular Mimic of a Spinal Cord Emergency.pubmed.ncbi.nlm.nih.gov
28. Cystic Medial Degeneration Leading to Popliteal Artery Aneurysm With Distal Embolization.pubmed.ncbi.nlm.nih.gov
29. Open Repair of a Giant Superficial Femoral-Popliteal Artery Aneurysm Using Autologous Saphenous Vein Bypass: A Case Report.pubmed.ncbi.nlm.nih.gov
30. Endovascular Treatment for a Huge Celiac Artery Aneurysm: 13-Year Follow-Up.pubmed.ncbi.nlm.nih.gov
31. Agenesis of the left pulmonary artery and cardiac hydatid cysts: A dual rarity.pubmed.ncbi.nlm.nih.gov
32. Transportal Embolization of the Dominant Outflow Vein for a Pancreatic Head Arteriovenous Malformation: A Case Report.pubmed.ncbi.nlm.nih.gov
33. Onyx Migration to the Middle Cerebral Artery Treated by Mechanical Thrombectomy with Subsequent Delayed Migration of Residual Onyx: A Case Report.pubmed.ncbi.nlm.nih.gov
34. CT Angiography of the Upper Extremities: Review of Acute Arterial Entities.pubmed.ncbi.nlm.nih.gov
35. Radiologic evaluation of the kidney transplant donor and recipient.pubmed.ncbi.nlm.nih.gov
36. Quality of extracranial carotid evaluation with 256-section CT.pubmed.ncbi.nlm.nih.gov
37. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines.pubmed.ncbi.nlm.nih.gov
38. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines.pubmed.ncbi.nlm.nih.gov
39. Intracranial venous thrombosis imaging by anatomical location: an educational review with mimics and diagnostic pitfalls.pubmed.ncbi.nlm.nih.gov
40. Giant cervical internal carotid artery aneurysm associated with multiple intra- and extracranial aneurysms: a case report.pubmed.ncbi.nlm.nih.gov
41. Recurrent Pulmonary Embolism After Pulmonary Endarterectomy During Rivaroxaban Therapy in a Resource-Limited Setting.pubmed.ncbi.nlm.nih.gov
42. Sequential bilateral common carotid artery occlusion in protein C deficiency and patent foramen ovale: illustrative case.pubmed.ncbi.nlm.nih.gov
43. Case Report: Intravascular lithotripsy combined with a new-generation 3-in-1 carotid stent for calcified carotid artery stenosis.pubmed.ncbi.nlm.nih.gov
44. Two Cases of Innominate Artery Stenting via Alternative Upper-Extremity Arterial Access Using Tailored Distal Protection Strategies.pubmed.ncbi.nlm.nih.gov
45. Acute Limb Ischemia During Pregnancy: A Case Report and Narrative Review of the Literature.pubmed.ncbi.nlm.nih.gov
46. Thrombolytic therapy in vertebrobasilar dolichoectasia patients with acute posterior circulation cerebral infarction: a case series analysis.pubmed.ncbi.nlm.nih.gov
47. Hybrid revascularization for acute common carotid artery occlusion after transcarotid transcatheter aortic valve implantation: illustrative case.pubmed.ncbi.nlm.nih.gov
48. Stent Retriever-Assisted Embolic Protection During Recanalization of Chronic Internal Carotid Artery Occlusion with Contralateral Carotid Stenosis: A Case Report.pubmed.ncbi.nlm.nih.gov
49. Intertrochanteric Femur Fracture in Severe Peripheral Vascular Disease Complicated by Acute Limb Ischemia and Amputation: A Case Report.pubmed.ncbi.nlm.nih.gov
50. Advanced Needle-Based Strategies for Complex Calcified Peripheral Artery Disease: A Systematic Review.pubmed.ncbi.nlm.nih.gov
51. Retrospective surgical outcomes of Gartland type III supracondylar humeral fractures with absent pulse in children.pubmed.ncbi.nlm.nih.gov
52. Contrast-enhanced ultrasound in critical care: a problem-solving approach.pubmed.ncbi.nlm.nih.gov
53. Feasibility of [¹⁵O]H₂O PET-CT for quantifying lower limb muscle perfusion in peripheral arterial occlusive disease: a pilot study.pubmed.ncbi.nlm.nih.gov
54. Research progress of remote ischemic conditioning in hemorrhagic stroke.pubmed.ncbi.nlm.nih.gov
55. Systematic review of benign thyroid enlargement as a rare cause of arterial compression: clinical presentations and outcomes.pubmed.ncbi.nlm.nih.gov
56. Ultrasound-guided continuous parasacral ischial plane block for diabetic foot ulcer healing: study protocol for a single-centre, prospective, randomised, open-label, blinded-endpoint controlled trial.pubmed.ncbi.nlm.nih.gov
57. Multiterritory Bihemispheric Ischemic Stroke in the Setting of Unilateral Internal Carotid Artery Disease.pubmed.ncbi.nlm.nih.gov
58. Rupture of the Uterine Artery Pseudoaneurysm Causing Late Postpartum Hemorrhage: Case Report and Literature Review.pubmed.ncbi.nlm.nih.gov
59. Deep Medullary Vein Asymmetry and Clinical Outcomes in Patients with Ischemic Stroke and Successful Endovascular Treatment.pubmed.ncbi.nlm.nih.gov
60. Aortoiliac fenestrated stent demonstrates superior flow dynamics to kissing iliac stents in a large animal.pubmed.ncbi.nlm.nih.gov
61. Infrared thermography and dual-layer spectral CT for the detection of femoral vascular compromise: an experimental large animal study.pubmed.ncbi.nlm.nih.gov
62. Supra-aortic bypass reconstructions using ring-reinforced 8 mm polytetrafluoroethylene for debranching before thoracic endovascular aortic repair and for atherosclerotic lesions of the subclavian artery.pubmed.ncbi.nlm.nih.gov
63. Prognostic value of the systemic immune-inflammation index in acute limb ischemia undergoing endovascular therapy.pubmed.ncbi.nlm.nih.gov
64. Specialist Palliative Care Service Involvement and Prognostic Factors in Patients Presenting With Acute Limb Ischaemia to Waikato Hospital, Hamilton, New Zealand: A Retrospective Review.pubmed.ncbi.nlm.nih.gov
65. Midterm Outcomes of Endovascular-First Revascularization for Multilevel Peripheral Arterial Disease With Chronic Limb-Threatening Ischemia: A Retrospective Study From Vietnam.pubmed.ncbi.nlm.nih.gov
66. Case Report: A successful percutaneous revascularization of bilateral acute limb ischemia caused by an aortic saddle embolism in a patient with mitral stenosis.pubmed.ncbi.nlm.nih.gov
67. Unusual painless upper limb ischemia in a patient with diabetes. A case study.pubmed.ncbi.nlm.nih.gov
68. Serum endocan levels in patients with peripheral artery disease: an exploratory cross-sectional study.pubmed.ncbi.nlm.nih.gov
69. Study Protocol for the Evaluation of Morphologic and Imaging Remodeling of Atherosclerotic Plaque Following Intravascular Lithotripsy in Peripheral Artery Disease.pubmed.ncbi.nlm.nih.gov
70. Clinical outcome of extremity arterial injuries in the modern era.pubmed.ncbi.nlm.nih.gov
71. Endovascular Repair of Thoracic Aortic Atresia in Adults: A Narrative Review of a Rare Entity and Emerging Technique.pubmed.ncbi.nlm.nih.gov
72. The BG Study Part 1 (Bergisch Gladbach): Development of a Prototype Coronary Artery Disease Risk Score Incorporating Peripheral Vascular Parameters-Preliminary Insights for Future CAD Risk Prediction Models in Vascular Patients.pubmed.ncbi.nlm.nih.gov
73. Computed tomography perfusion stroke mimics on RAPID commercial software: A case-based review.pubmed.ncbi.nlm.nih.gov
74. Intrapleural left axillary artery bypass grafting compromising subsequent left internal thoracic artery harvesting: a case report.pubmed.ncbi.nlm.nih.gov
75. Catastrophic STS/SVS type B3 aortic dissection complicated by hepatic portal venous gas and multi-organ malperfusion: a case report.pubmed.ncbi.nlm.nih.gov
76. Modernizing Aortic Dissection Classification in the Era of Endovascular and Hybrid Repair: Implications for Radiology Reporting.pubmed.ncbi.nlm.nih.gov
77. Arc of Buhler pseudoaneurysm complicated by an arterioportal fistula: a combined endovascular and open surgical approach.pubmed.ncbi.nlm.nih.gov
78. When Cancer Clots: An Extensive Radiologic Analysis of Cancer-Associated Thromboembolism.pubmed.ncbi.nlm.nih.gov
79. The Role of Interventional Radiology in the Diagnosis and Treatment of Gynecological Conditions.pubmed.ncbi.nlm.nih.gov
80. Venous Thromboembolism in Neonates, Children, and Adolescents: A Comprehensive Narrative Review of Risk Factors, Diagnosis, Treatment, and Prevention.pubmed.ncbi.nlm.nih.gov
81. Optimization of Bolus-Tracking Thresholds levels in Cerebral CT Angiography: Influence of Patient Characteristics on contrast enhancement dynamics and radiation dose metrics.pubmed.ncbi.nlm.nih.gov
82. Multimodal imaging in neuro-ophthalmology.pubmed.ncbi.nlm.nih.gov
83. Contrast medium dose optimization in the era of multi-energy CT.pubmed.ncbi.nlm.nih.gov
84. High-affinity alphavbeta3 integrin targeted optical probe as a new imaging biomarker for early atherosclerosis: initial studies in Watanabe rabbits.pubmed.ncbi.nlm.nih.gov
85. Diffusion-Weighted Imaging in the Musculoskeletal System: Evolving Role in Modern Imaging Practice.pubmed.ncbi.nlm.nih.gov
86. Neuroimaging with photon-counting computed tomography: A review of clinical applications.pubmed.ncbi.nlm.nih.gov
87. Computed tomography and magnetic resonance imaging for pulmonary embolus evaluation in children: up-to-date review on practical imaging protocols.pubmed.ncbi.nlm.nih.gov
88. Detection of Microvascular Failure Using Bioimpedance and Sensor-derived Clinical Indicators: A Preliminary Study.pubmed.ncbi.nlm.nih.gov
89. Revascularization for Acute Limb Ischemia.pubmed.ncbi.nlm.nih.gov
90. Clinical outcomes of flap reconstruction following lower extremity soft tissue sarcoma resection: a single-center retrospective experience.pubmed.ncbi.nlm.nih.gov
91. Dedicated Single-Branch Platforms for Totally Endovascular Zone 2 TEVAR with LSA Revascularization: A Comparison of Castor/Cratos and Gore TAG Thoracic Branch Endoprosthesis.pubmed.ncbi.nlm.nih.gov
92. Callosomarginal artery: an in-depth of anatomical characteristics, clinical significance, neurosurgical considerations, and surgical applications.pubmed.ncbi.nlm.nih.gov
93. Brazilian Angiology and Vascular Surgery Society Guidelines for the treatment of extracranial cerebrovascular disease.pubmed.ncbi.nlm.nih.gov
94. Non-stenotic Carotid Disease: Review of the Literature and Case Discussion of TCAR for Treatment.pubmed.ncbi.nlm.nih.gov
95. From anatomy to vulnerability: A comprehensive appraisal of coronary physiology and plaque characterization.pubmed.ncbi.nlm.nih.gov
96. Cardiovascular imaging with total-body PET.pubmed.ncbi.nlm.nih.gov
97. Transarterial embolization in musculoskeletal care: an indication-stratified narrative review.pubmed.ncbi.nlm.nih.gov
98. Clinical feasibility of primary retrograde endovascular therapy via trans-ankle intervention: a retrospective single-center study.pubmed.ncbi.nlm.nih.gov
99. Coil only middle meningeal artery embolization for the treatment of subdural hematoma: a single center experience.pubmed.ncbi.nlm.nih.gov
100. Endovascular management of tandem embolic stroke due to cardioembolic free-floating thrombus: a case report.pubmed.ncbi.nlm.nih.gov
101. Left atrial myxoma complicated by abdominal aortic embolization: A case report.pubmed.ncbi.nlm.nih.gov
102. Aneurysm of a Supra-Articular Branch of the Popliteal Artery Mimicking a Soft-Tissue Sarcoma: A Case Report.pubmed.ncbi.nlm.nih.gov
103. Traumatic common iliac artery occlusion mimicking acute sciatica: a case report.pubmed.ncbi.nlm.nih.gov
104. Massive rectus sheath hematoma following anticoagulation requiring operative hemorrhage control: a case report.pubmed.ncbi.nlm.nih.gov
105. Severe arterial hypertension, a silent complication of Williams-Beuren syndrome: A case report with literature review.pubmed.ncbi.nlm.nih.gov
106. Calciphylaxis Mimicry in End-Stage Renal Disease: Acute Limb Ischemia From Calcific Peripheral Arterial Disease.pubmed.ncbi.nlm.nih.gov
107. Vascular and lymphatic complications after renal transplant.pubmed.ncbi.nlm.nih.gov
108. Ultrasound evaluation of clinical mimics of deep vein thrombosis: essential insights for radiologists in interpretation.pubmed.ncbi.nlm.nih.gov
109. Society for Cardiovascular Magnetic Resonance 2024 Cases of SCMR case series.pubmed.ncbi.nlm.nih.gov
110. Intravascular Ultrasound (IVUS)-Guided Endovascular Treatment of Severe Left Subclavian Artery Stenosis in a Patient With High-Risk Post-Coronary Artery Bypass Grafting Surgery.pubmed.ncbi.nlm.nih.gov
111. Computed tomography predictors of failure of conservative management in isolated superior mesenteric artery dissection.pubmed.ncbi.nlm.nih.gov
112. Case Report: Mechanical thrombectomy of cerebral venous sinuses using the NeVa stent retriever.pubmed.ncbi.nlm.nih.gov
113. Spontaneous Non-Aneurysmal Convexity Subarachnoid Hemorrhage: A Scoping Review of Different Etiologies beyond Cerebral Amyloid Angiopathy.pubmed.ncbi.nlm.nih.gov
114. An Integrated Approach on the Diagnosis of Cerebral Veins and Dural Sinuses Thrombosis (a Narrative Review).pubmed.ncbi.nlm.nih.gov
115. Pulmonary arteries: imaging of pulmonary embolism and beyond.pubmed.ncbi.nlm.nih.gov

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.