Sol yerleşimli VKI

Özet

Sol yerleşimli VKI, infrarenal ana venöz gövdenin aortanın solunda yükseldiği ve çoğunlukla sol renal ven düzeyinde orta hattı geçerek sağ suprarenal VKI'ye katıldığı gelişimsel bir varyanttır. Kontrastlı BT'de iliak venöz dönüşten sol renal ven birleşimine uzanan damar devamlılığı, bu varyantı tanımlamaya ve tek kesitte kitleyi taklit edebilecek yapıyı damar olarak ayırt etmeye yardımcı olur. Bu güzergâhın bilinmesi retroperitoneal cerrahi ve endovasküler girişim planlamasında önem taşır. Renal ven düzeyindeki bağlantının izlenemediği durumlarda, drenajın azygos veya hemiazygos sistemine yöneldiği kaval kesintisi ile ayırıcı tanıda düşünülmelidir.

Faz ve pencere

Portal tanısal

Venöz opasifikasyonlu abdomen-pelvis BT'de aortanın solunda yükselen infrarenal gövdenin sol renal vene birleşimi ve renal venin sağa geçerek normal kanala katılımı izlenir; kontrastlanan damarın bütünlüğü komşu yumuşak dokudan ayrılmasını sağlar.

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

BT bulguları

• İnfrarenal ana venöz gövde aortanın solunda, sol paravertebral hatta yükselir.
• Sağ ortak iliak venin sol tarafa geçerek sol ortak iliak venle birleşip infrarenal gövdeyi oluşturması izlenir; çift VKI ayırımı için sağda ikinci bir kanal varlığı ayrıca değerlendirilir.
• Sol VKI çoğunlukla sol renal ven düzeyinde sonlanır; sol renal ven aortanın önünden sağa geçerek sağ suprarenal VKI'ye boşalır.
• Renal venlerin altındaki aortanın sağında ikinci bir infrarenal kanal bulunmaması, çift VKI'den ayıran temel gözlemdir.
• Tipik olarak sol gövde sol renal ven düzeyinde sonlanır ve sağa geçerek hepatik segmenti oluşturur; bu çapraz bağlantı yoksa drenaj azygos sistemine yönelebilir.
• Aksiyal görüntüler sol paravertebral kanalı gösterir; koronal MPR, iliak venöz dönüşten renal ven üzerinden sağa geçişe uzanan devamlılığı göstermeye yardımcı olur.
• Kontrastlanan tübüler yapı, kesitler boyunca damar biçimini ve venöz dallarla devamlılığını korur; izole nodal kitle görünümü vermez.

Normalde

Normal VKI infrarenal düzeyden başlayarak aortanın sağında yükselir; sol renal ven aortanın önünden sağa geçip bu kanala dökülür. İzole sol yerleşimli VKI'de temel taraf farklılığı infrarenal gövdededir; renal hilus altındaki aksiyal kesitlerde iliak ven bağlantısını, koronal MPR'de ise sol renal ven üzerinden sağ suprarenal VKI'ye geçişi izleyin.

Ayırıcı tanı

Çift VKI

sol renal ven seviyesinin altında aortanın sağında da ikinci infrarenal venöz kanal bulunur.

VKI kesintisi ve azygos/hemiazygos devamlılığı

infrahepatik VKI'nin kesintili olduğu durumlarda venöz drenaj azygos veya hemiazygos sistemine yönelir; hepatik venler ise doğrudan sağ atriyuma boşalır.

Paraaortik lenf nodu

nodal doku sol paravertebral yerleşebilir ancak iliak venlerden gelen lümen devamlılığı ve renal ven birleşimi göstermez.

Retroaortik sol renal ven

sol renal ven aortanın arkasından geçtiği halde, sol yerleşimli VKI'de gövde genellikle sol renal ven düzeyinde aortanın önünden sağa çaprazlar.

Paraaortik lenf nodu veya tümör

sol paravertebral bölgede yer alan anomali, kontrastlı BT'de lenfadenopati veya yumuşak doku kitesi olarak yanlış yorumlanabilir; venöz dallarla devamlılık ve iliak birleşim izlenerek damar yapısı ayrılmalıdır.

Tuzaklar

• Renal venin aortanın önünden geçişini tek başına retroaortik ven diye adlandırma; infrarenal VKI gövdesinin hangi tarafta yükseldiğini kaudal kesitlerden belirle.
• Sol paravertebral kanalın yalnız bir kesitini görmek kitle izlenimi verebilir; iliak başlangıca ve sol renal ven birleşimine kadar multiplanar takip et.
• Renal ven üstünde sağ suprarenal VKI görülmesi, alt segmentin de sağ tarafta olduğu anlamına gelmez.

Kendini dene

1. İnfrarenal ana ven aortanın solunda; sol renal ven önden sağa geçerek sağ suprarenal kanala açılıyor. Tanı nedir?

   • Çift VKI
   • Sol yerleşimli VKI
   • Retroaortik renal ven
   • Azygos devamlılığı
   Cevabı göster

   Sol yerleşimli VKI. Sol tarafta tek infrarenal gövdenin sol renal ven üzerinden sağa dönüşü sol yerleşimli VKI'yi tanımlar. Çift VKI'de renal ven altı sağda ikinci kanal vardır; retroaortik renal vende VKI sağdadır; azygos devamlılığında kraniyal kaval segment kesintilidir.

2. Aortanın solundaki kontrastlanan tübüler yapı iliak venöz dönüşten sol renal vene kesintisiz bağlanıyor ve aortanın sağında ikinci infrarenal kanal görülmüyor. En olası seçenek hangisidir?

   • Paraaortik lenf nodu
   • Sol yerleşimli VKI
   • Üreter taşı
   • Adrenal kitle
   Cevabı göster

   Sol yerleşimli VKI. İliak venöz dönüşten renal ven birleşimine uzanan kesintisiz damar lümeni ve sağda ikinci infrarenal kanalın görülmemesi sol yerleşimli VKI lehinedir. Sol yerleşimli VKI, BT'de paraaortik lenfadenopati olarak yanlış yorumlanabileceğinden damar anatomisi dikkatle değerlendirilmelidir.

İlgili konular

• Çift VKI
• İnfrarenal/hepatik VKI yokluğu veya kesintisi

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 8 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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