İliak ven trombozu

Özet

İliak ven trombozu, pelvik bölgede uzanan ortak, internal veya eksternal iliak ven segmentini tutar ve bacağın şişmesi ya da ağrısıyla ortaya çıkabilir. BT venografi, ultrasonografide görüntülenemeyen pelvik venleri ve trombüsün proksimalde vena cava inferiora veya distalde femoral vene olan uzanımını değerlendirmeyi sağlar. Akut dönemde trombüs, kontrastlı BT venografide lümen içinde dolmayan bir defekt olarak görünürken; kronik obstrüksiyonda kasık ve alt karın bölgesinde belirgin venöz kollateraller izlenebilir. Pelvik çıkış tıkanıklığının yeri ve sınırları atlanırsa venöz hastalık yalnız bacağa indirgenmiş olur.

Faz ve pencere

Gecikmiş tanısal

Yeterli venöz opasifikasyonda ortak iliak ven bifurkasyondan kaval bileşkeye, eksternal iliak ven inguinal ligamente ve internal iliak dallar pelvis içine doğru izlenir; trombüs sabit intralüminal defekt, kesintili dolum veya oklüzyon olarak belirir.

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

BT bulguları

• Ortak, internal ya da eksternal iliak ven içinde kontrastın çevrelediği kalıcı lümen defekti
• Akut dönemde iliak venlerde heterojen yoğunluklu kalınlaşma izlenebilir.
• Trombüsün ana femoral vene veya vena cava inferiora uzandığı kesintisiz venöz yayılım
• İliak ven tıkanıklıklarında kasık ve alt karın bölgesi boyunca belirginleşen kollateral venler izlenebilir.
• Kronik iliak ven obstrüksiyonlarında damar çevresinde gelişen yoğun kollateral venöz drenaj izlenebilir.
• Damarı dıştan yer değiştiren lenf nodu veya pelvik yumuşak doku kitlesi

Normalde

BT venografide şüpheli ortak iliak venin kontrastlanması karşı taraf ortak iliak venle karşılaştırılabilir. Sabit intralüminal defekt, çevre yağ dokusunda ödem veya belirgin presakral yan damarlar görülmez. Aynı düzeyde karşı taraf venini ve komşu arterin açık lümenini referans alın.

Ayırıcı tanı

Non-trombotik iliak ven basısı

özellikle ortak iliak segment yassılaşır, fakat ven lümeninde kalıcı pıhtı görünmez.

Pelvik kitle basısı

ven dıştan itilmiş veya daralmıştır; komşu kitle ya da lenfadenopati ayrı bir yapı olarak seçilir.

Posttrombotik venöz daralma

küçülmüş düzensiz damar, ince rekanalizasyon ve kronik yan damarlarla birliktedir.

Venöz kontrastlanma eşitsizliği

lümen opasitesi damar boyunca veya görüntü fazı değiştikçe farklılaşır.

Tuzaklar

• İliak venin arter komşuluğunda yassı görünmesi yaygın anatomik varyanttır; yalnız bu kontura bakarak tromboz veya klinik sendrom tanısı koymayın.
• Venöz faz erken kaldığında iç iliak dallar ve karşı taraf ortak iliak ven sönük görünebilir; önce ana femoral venlerden kaval bileşkeye uzanan kontrast dengesini kontrol edin.
• Presakral damarlar kronik venöz dönüş değişikliğini düşündürür, fakat tek başına hangi iliak segmentin tıkalı olduğunu belirlemez; ana lümeni baştan sona izleyin.

Kendini dene

1. BT venografide sol ortak iliak ven genişlemiş ve trombüs nedeniyle kontrastlanmıyor. Bu BT venografi bulgusu en çok hangi durumu düşündürür?

   • Akut iliak ven trombozu
   • Pelvik lenfadenopati
   • İzole venöz bası
   • Akım karışım artefaktı
   Cevabı göster

   Akut iliak ven trombozu. Ven lümenindeki kalıcı defekt ve çevre ödem birlikte akut iliak trombozu destekler. Lenfadenopati damar dışındadır; bası lümeni dıştan daraltır; karışım artefaktı dengeli venöz opasifikasyonda sabit kalmaz.

2. İnternal iliak dallar geniş ve kıvrımlı; ana iliak venlerde lümen defekti yok. En olası eşlik eden durum?

   • Pelvik venöz kollateralizasyon
   • Arteriyel diseksiyon
   • Lenfatik malformasyon
   • Üreter taşı
   Cevabı göster

   Pelvik venöz kollateralizasyon. Genişlemiş pelvik ven dalları venöz yan dolaşımı düşündürür; ana venlerde trombüs gösterilmediğinden akut iliak tromboz denemez. Diğer seçenekler damarların venöz seyri ve kontrastlanma örüntüsüyle uyuşmaz.

İlgili konular

• İliokaval derin ven trombozu
• Alt ekstremite derin ven trombozu (BT venografide)

Kaynaklar

Bu sayfadaki 35 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 13 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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