Alt ekstremite derin ven trombozu (BT venografide)

Özet

Alt ekstremite derin ven trombozunda ilk inceleme çoğunlukla ultrasonografidir; BT venografi, özellikle proksimal uzanımın veya pelvisle bağlantının kesitsel haritalanması gerektiğinde tamamlayıcı bilgi sağlar. Femoral, popliteal ve baldır venlerinde tanısal bulgu, yeterince opaklaşmış lümen içinde kesitler boyunca izlenen sabit dolum defektidir. Akut ven genişlemesi ve çevresel ödem eşlik edebilir; eski tromboz küçük düzensiz lümen ve yan damarlarla seyredebilir. Trombozun hangi segmentte sonlandığını bildirmemek, aynı ekstremitedeki proksimal venöz hastalığı gözden kaçırabilir.

Faz ve pencere

Gecikmiş tanısal

Femoralden popliteal ve baldır derin venlerine uzanan venöz opasifikasyonda lümen içindeki sabit, kontrastla çevrili defekt gösterilir; akut olguda ven genişlemesi ve komşu yumuşak dokuda ödem görülebilir.

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

BT bulguları

• Femoral ven lümeninde kesitler boyunca devam eden santral veya eksantrik kontrast çevreli defekt
• Popliteal venin diz arkası boyunca genişleyip kontrastlı lümenin daralması ya da kesilmesi
• Baldır derin venlerinden popliteal segmente doğru devam eden intralüminal pıhtı
• Akut tıkalı segment çevresinde cilt altı ödemi ve yağ planlarında silikleşme
• Kronik dönemde küçülmüş, düzensiz ven lümeni içinde ince ağsı yeniden kanal oluşumu
• Femoral trombüsün proksimalde ortak femoral vene ve eksternal iliak vene uzanması

Normalde

Kombine BT venografide pelvis ve alt ekstremite venöz sisteminin tüm anatomik düzeyleri görüntülenebilir. Aynı seviyede iki bacağı ve arter-ven çiftini karşılaştırarak gerçek lümen içi materyali ayırt edin.

Ayırıcı tanı

Venöz kontrast karışımı

lümende yamalı düşük opasite oluşturabilir ve daha dengeli venöz görüntüde kaybolabilir.

Kronik posttrombotik değişiklik

daralmış ve düzensiz venle birlikte ağsı kanallar gösterir; akut genişleme beklenen görünüm değildir.

Tuzaklar

• Doğrudan BT venografide bazı venlerin enjeksiyon eksikliği veya büyük safen ven-femoral ven birleşimindeki türbülans, intralüminal dolum defekti ile karıştırılabilecek yapay düşük yoğunluk oluşturabilir; bu nedenle bulgu ardışık kesitlerde doğrulanmalıdır.
• Tek taraflı cilt altı ödemi trombozun yeri değildir; femoral ve popliteal ven lümenini doğrudan izleyip ödemi eşlikçi bulgu olarak kaydedin.
• Pulmoner anjiyografi sonrası dolaylı venöz görüntülerde zamanlama bacak damarlarını eşit opaklaştırmayabilir; düşük opasiteyi tromboz saymadan incelemenin teknik yeterliliğini değerlendirin.

Kendini dene

1. Uyluk venöz faz görüntülerinde femoral ven boyunca sabit, kontrastla çevrili intralüminal materyal seçiliyor. Tanı nedir?

   • Derin ven trombozu
   • Yüzeyel tromboflebit
   • Baker kisti
   • Popliteal arter anevrizması
   Cevabı göster

   Derin ven trombozu. Derin venin kendi lümeninde devamlı sabit dolum defekti tromboz lehinedir. Derin ven lümenindeki dolum defekti trombozu destekler.

2. Diz arkasında gastroknemius-semimembranozus bursasının genişlemesiyle oluşan, sinovyal sıvı içeren kistik yapı görülüyor. En olası tanı?

   • Baker kisti
   • Derin ven trombozu
   • Femoral arter anevrizması
   • Lenf nodu
   Cevabı göster

   Baker kisti. Gastroknemius-semimembranozus bursasının sinovyal sıvı içeren genişlemesi Baker kistiyle uyumludur. Baker kisti gastroknemius-semimembranozus bursasının sinovyal sıvı içeren genişlemesidir; femoral ven içindeki dolum defekti ise akut trombozu destekler.

İlgili konular

• İliak ven trombozu
• İliokaval derin ven trombozu

Kaynaklar

Bu sayfadaki 32 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 6 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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