Karotis psödoanevrizması

Özet

Karotis psödoanevrizması, damar duvarındaki hasardan sızan kanın çevre dokular veya adventisya tarafından sınırlanmasıyla oluşan, travma, diseksiyon, cerrahi ya da enfeksiyon sonrası gelişebilen bir lezyondur. BTA, ana arterle bağlantılı kontrastlanan keseyi, kısmi trombozu, eşlik eden darlığı ve çevre hematomu hızla ortaya koyar. Lezyon rüptür, boyun kanaması veya distal tromboemboli/inme ile sonuçlanabilir; küçük kesenin ya da komşu duvar hasarının gözden kaçması tanıyı geciktirir. BT duvar katmanlarını doğrudan gösteremediği için travmatik öykü ve eşlik eden diseksiyon bulguları morfolojiyle birlikte yorumlanmalıdır.

Faz ve pencere

BTA tanısal

Arteriyel BTA'da internal karotis lümeninden kese içine uzanan kontrast kolonu, dar kese boynu, değişken sakküler çıkıntı, mural trombüs, eşlik eden lümen darlığı ve perivasküler hematom aranır; aktif ekstravazasyon varsa kontrast damar sınırının dışına çıkar.

Kontrastsız

Travma veya rüptür şüphesinde kontrastsız boyun BT'sinde kese çevresinde yüksek dansiteli akut kan ve derin boyun planlarında hematom görülebilir; damar ile kese arasındaki akım bağlantısını göstermez.

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

BT bulguları

• Internal karotis arter dış konturundan kese biçimli kontrastlanma çıkar ve dar ya da geniş bir boyunla ana lümene bağlanır.
• BT anjiyografide kese, ana arterle aynı fazda kontrastlanır; heterojen dansite veya eksantrik dolum kusuru kısmi trombüs veya hematomu düşündürebilir.
• Komşu internal karotis lümeni mural hematom veya kese basısı nedeniyle daralmış, düzensiz ya da eksantrik olabilir.
• Eşlik eden intimal flep, çift lümen veya uzun segment duvar kalınlaşması travmatik diseksiyon bileşenini destekler.
• Çevre yumuşak dokuda akut kanama yüksek dansiteli hematom; kontrast sınırının dışına taşan odak ise aktif ekstravazasyon düşündürür.
• CTA'da metal fragmanlara bağlı şerit artefaktı vasküler lezyonun görülmesini güçleştirebilir; klinik şüphe sürüyorsa anjiyografiyle ileri değerlendirme yapılabilir.
• Distal ICA ve intrakraniyal arterlerde dolum kusuru veya kesinti, emboli ya da ilişkili oklüzyon açısından incelenir.

Ölçütler ve sınıflamalar

Biffl/Denver künt serebrovasküler yaralanma derecelendirmesi

Travmatik psödoanevrizma derece III’tür. Derece I hafif intimal düzensizlik veya <%25 daralma; derece II intimal flep ya da intraluminal trombüs veya >%25 daralma yapan diseksiyon/intramural hematom; derece IV oklüzyon; derece V transeksiyon ve/veya arteriovenöz fistüldür. Bu sınıflama travmatik yaralanma içindir; spontan ya da enfeksiyöz psödoanevrizmanın evresi değildir.

Normalde

Aynı düzeyde normal internal karotis arter, duvar dışına taşan kontrastlı kese olmadan düzgün kontur ve kesintisiz lümen gösterir; çevresindeki derin boyun yağ planlarında hematom bulunmaz. Doğru tanı için ayırıcı tanıda kılavuzluk etmesi amacıyla komşu yapılarla kıyaslanmalı; kese biçimli yapının ana arterle olan bağlantısı ardışık kesitlerde doğrulanarak olası anatomik varyantlar ve taklitçiler elenmelidir.

Ayırıcı tanı

Gerçek anevrizmalar genellikle düzgün fusiform genişlemedir; travma, enfeksiyon veya cerrahi öyküsü olmadan CTA tek başına gerçek ve yalancı anevrizmayı kesin olarak ayırt etmeyebilir.

Karotis diseksiyonu

uzun segmentli eksantrik daralma, intimal flep ve duvar içi hematom vardır; belirgin kese bulunmayabilir.

Aktif karotis rüptürü

damar dışına yayılan kontrast ve hızla büyüyen hematom ön plandadır; sınırlı kese içinde kalan opasifikasyondan ayrılır.

Karotis cisimciği paraganglioması

bifurkasyonda damarları ayıran, belirgin kontrastlanan yumuşak doku kitlesidir; ana arterden dolan boyunlu kese değildir.

Juguler ven trombozundan ayrımda, psödoanevrizmanın karotis arter bifurkasyonuyla iletişiminin gösterilmesi tanıyı destekler.

Tuzaklar

• Karotis psödoanevrizmasına mural trombüs eşlik edebilir.
• Psödoanevrizma ile gerçek anevrizmanın histolojik ayrımı CT çözünürlüğüyle güvenilir biçimde yapılamaz; travma, girişim, enfeksiyon ve eşlik eden diseksiyon bilgisini raporlamaya kat.
• CTA'da metal fragmanlara bağlı şerit artefaktı vasküler lezyonun görülmesini güçleştirebilir; klinik şüphe sürüyorsa anjiyografiyle ileri değerlendirme yapılabilir.
• Tek kesitte venöz kontrast karışımı veya anatomik varyantlar pseödoanevrizma ile taklitçi olabilir; doğru tanı için yapının ana arterle devamlılığı ardışık kesitlerde ve komşu yapılarla ilişkilendirilerek doğrulanmalıdır.

Kendini dene

1. BTA'da karotis bifurkasyonuyla iletişim gösteren pulsatif vasküler lezyon saptanıyor. En uygun tanı hangisi?

   • Karotis psödoanevrizması
   • Karotis cisimciği tümörü
   • Juguler ven trombozu
   • Aterosklerotik plak
   Cevabı göster

   Karotis psödoanevrizması. Karotis arter bifurkasyonuyla iletişim gösteren pulsatif vasküler lezyon psödoanevrazmayı destekler; çevre hematom eşlik edebilir. Karotis cisimciği paraganglioması bifurkasyonda yerleşen hipervasküler bir kitledir; karotis arterle iletişim gösteren vasküler lezyon psödoanevrizmayı destekler.

2. BTA'da karotis arterinde intimal flep ve intramural hematomla uyumlu bulgular var; kese görülmüyor. Tanı nedir?

   • Karotis diseksiyonu
   • Sakküler anevrizma
   • Arteriyovenöz fistül
   • Karotis cisimciği tümörü
   Cevabı göster

   Karotis diseksiyonu. Karotis arterinde intimal flep ve intramural hematom diseksiyonu destekler. Bu bulgular diseksiyonu destekler; psödoanevrizma, oklüzyon, transeksiyon ve arteriovenöz fistül farklı damar yaralanması türleridir.

İlgili konular

• Ekstrakraniyal karotis arter anevrizması

Kaynaklar

Bu sayfadaki 41 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 15 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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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.