Ekstremite arteriyel aktif kanama

Özet

Travma veya girişim sonrası ekstremite arteri yaralanmaları kanama, genişleyen hematom ve doku iskemisi ile seyredebilir. Arteriyel BTA'da damar lümeni dışında kan havuzuna benzeyen kontrast odağı aranır; varsa gecikmiş seri odağın büyümesini veya çevre dokulara yayılmasını gösterir. Ekstremite arter yaralanmalarında aktif kanamaya büyük bir hematom eşlik edebilir. Aktif kanama sınırlı psödoanevrizma ya da yalnız hematom olarak yorumlanırsa devam eden kan kaybı gözden kaçabilir.

Faz ve pencere

BTA tanısal

Arteriyel fazda ekstravaze kontrast, arter lümeninden ayrı ancak arteriyel kan havuzuna benzer yoğunlukta odak veya düzensiz havuz şeklindedir; kaynak damarla doğrudan devamlılık aranır.

Gecikmiş tanısal

Gecikmiş görüntüde aktif kanama odağı genellikle büyür, biçimi değişir veya hematom içinde daha geniş alana yayılır; sabit sınırlı kontrast kesesiyle karşılaştırma bu fazın katkısıdır.

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

BT bulguları

• Damar dışı kontrast havuzu — opak arter lümeninden ayrı, çevre hematom içinde arteriyel yoğunlukta yeni odak.
• Arteriyel kan havuzuyla benzer opasifikasyon — odağın arteriyel seri içinde belirginleşmesi aktif arter kaynağını destekler.
• Düzensiz veya kenarı belirsiz ekstravazasyon — sınırlı kese yerine komşu hematom aralıklarına yayılan kontrast.
• Gecikmiş seride büyüme — odağın çapı, hacmi veya yayılım alanının sonraki seride artması.
• Kaynak arterde duvar kesintisi — kanama odağına komşu damar lümeninde düzensizlik, kesinti veya yaralanma.
• Kompartman içi hematom — BT'de kompartman ödemine eşlik eden intramüsküler hematom görülebilir.
• Eşlik eden psödoanevrizma — ekstravazasyon odağına komşu sınırlı kontrast kesesi ve damar bağlantısı.

Normalde

Normal BT anjiyografide kontrast damar lümeni içinde kalır; damar dışı kontrast birikimi patolojik ekstravazasyonu gösterir. Teknik açıdan kuşkulu damar opaklaşmasını değerlendirirken, görüntü alanına her iki ekstremiteyi alıp bulguları iki taraf arasında karşılaştırın.

Ayırıcı tanı

Psödoanevrizma

arterle boyun üzerinden bağlantılı, daha sınırlı ve kese biçimli kontrastlanan yapı; seriler arasında sınırsız yayılma beklenmez.

Arteriyovenöz fistül

erken opaklaşan komşu ven ve arter-ven bağlantısı vardır; ana bulgu damar dışı hematom içine kontrast kaçağı değildir.

Kontrastlanmayan hematom

spontan hiperdensiteleri kontrastsız ve kontrastlı görüntüleri karşılaştırarak kontrast dağılımından ayırt edin.

Yalancı ekstravazasyon/metal artefaktı

tek kesitte yüksek dansiteli görünüm oluşturabilir; ardışık düzlemde gerçek kontrast havuzu sürekliliği göstermez.

Venöz kanama

venöz/gecikmiş seride belirginleşebilir; arteriyel seriyle eş zamanlı parlak odak olmayabilir.

Tuzaklar

• Tek bir aksiyel kesitteki parlak odağı kanama saymayın; damarla bağlantısını ardışık kesit ve multiplanar görüntülerde doğrulayın.
• Psödoanevrizmayı aktif ekstravazasyon olarak adlandırmayın; sınırlı kese konturunu ve arterle bağlantı boynunu takip edin.
• Arteriyel seri negatif diye kanamayı dışlamayın; düşük debi veya erken tarama zamanlamasında gecikmiş görüntü ve klinik seyir önemli olabilir.
• Gecikmiş fazda büyüyen odağı fazlar arası farklı kesit düzeylerinden kaynaklı ölçüm hatasıyla karıştırmayın; aynı anatomik düzlem ve hacimde kıyaslayın.

Kendini dene

1. Travma BTA'sında femoral arter dışında düzensiz kontrast havuzu görülüyor ve gecikmiş seride çevre kasa doğru genişliyor. En olası bulgu nedir?

   • Aktif ekstravazasyon
   • Psödoanevrizma
   • Arteriyovenöz fistül
   • Venöz varis
   Cevabı göster

   Aktif ekstravazasyon. Damar dışı kontrastın gecikmiş seride büyümesi devam eden kanamayı destekler. Psödoanevrizma sınırlı kese, fistül erken ven doluşu yapar; varis venöz genişlemedir.

2. Arter komşuluğunda sınırlı yuvarlak kontrast kesesi ve dar bir boyun var; gecikmiş görüntüde kese biçimi değişmiyor. Tanı nedir?

   • Psödoanevrizma
   • Aktif ekstravazasyon
   • Arteriyovenöz fistül
   • Kontrast artefaktı
   Cevabı göster

   Psödoanevrizma. Sabit biçimli, arterle boyun üzerinden ilişkili kese psödoanevrizmayı gösterir. Serilerde büyüyüp doku planları arasında yayılan kontrast aktif ekstravazasyonu; arter ile komşu ven arasında doğrudan bağlantı ve erken ven doluşu ise arteriyovenöz fistülü gösterir.

İlgili konular

• Alt ekstremite arter travması
• Alt ekstremite travmatik/iatrojenik psödoanevrizması

Kaynaklar

Bu sayfadaki 37 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 8 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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