Renal ven trombozu

Özet

Akut yan ağrısı, hematüri veya böbrek işlevinde bozulma bulunan; nefrotik sendromu, malignitesi ya da hiperkoagülabilitesi olan hastada renal ven trombozu düşünülür. Kontrastlı BT, renal ven içindeki trombüsü doğrudan gösterir ve trombüsün ana venden inferior kaval ven'e uzanımını belirler; aynı zamanda etkilenen böbreğin parankimal kontrastlanmasını değerlendirmeye olanak tanır. Venöz çıkışın tıkanması böbrekte ödem ve venöz konjesyona neden olabilir; ayrıca eşlik eden pulmoner emboli riski klinik açıdan önemlidir. Tümör trombüsünün tümör dışı trombüsten ayırt edilmemesi, malignitenin evrelenmesini ve radyoloji raporunu değiştireceği için tedavi planlamasını doğrudan etkiler.

Faz ve pencere

Portal tanısal

Venöz/nefrografik kontrastlı görüntülerde renal ven içinde kontrastla çevrili düşük atenüasyonlu dolum defekti ve akut olguda genişlemiş ven görülür; böbrek büyümesi, nefrogramın azalması veya heterojenliği, renal sinüs ve perirenal ödem eşlik edebilir. Trombüsün ana renal venden inferior kaval vene (VKİ) doğru uzanımı, çok düzlümlü yeniden yapılandırmalarla birlikte değerlendirilir.

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

BT bulguları

• Renal ven dolum defekti — kontrastlı lümen içinde santral veya eksantrik düşük atenüasyonlu materyal.
• Akut ven genişlemesi — trombüs içeren renal venin karşı tarafa göre dolgun görünmesi.
• Nefrogram asimetrisi — etkilenen böbrekte azalmış ya da heterojen parankimal kontrastlanma.
• Böbrek büyümesi ve ödem — akut venöz konjesyonla birlikte parankim hacminde artış ve sinüs çevresinde bulanıklık.
• Perirenal ödem — renal fasya içinde yağ planlarının silinmesi veya çizgilenmesi.
• VKI uzanımı — renal ven trombüsünün ana kaval lümene süreklilik göstermesi.
• Tümör trombüsü olasılığı — renal kitleyle devamlılık gösteren ve kontrastlanan intravasküler yumuşak doku.

Normalde

Normalde ana renal venler böbrek hilusundan VKİ'ye kadar kontrastla homojen dolar ve lümenlerinde dolum defekti bulunmaz. İki böbreğin boyutunu, parankim kontrastlanmasını ve renal sinüs çevresi yağ planlarını yan yana kıyaslayın; sol renal venin seyri daha uzundur ve normal asimetri tek başına tromboz değildir.

Ayırıcı tanı

Tümör trombüsü

renal hücreli karsinom kitlesiyle devamlılık ve trombüs içinde kontrastlanma görülür.

Bland trombüs

lümen içi materyal belirgin kontrastlanmaz; komşu solid renal kitle beklenmez.

Renal enfarkt

ven lümeni açık olabilir; parankimde kama biçimli kontrastlanmayan alanlar öne çıkar.

Sol renal ven aortomezenterik segmentte daralır; tipik olarak trombüs yokken, sekonder RVT gelişmişse lümende trombüs görülebilir.

Akım karışım artefaktı

VKİ'de katmanlaşan kontrast, farklı faz veya düzlemde gerçek trombüs gibi görünebilir.

Tuzaklar

• Tümör ve bland trombüs birlikte bulunabilir; böbrek kitlesini ve trombüsün kontrastlanmasını ayrı ayrı inceleyin.
• Erken kontrast zamanlamasında venöz opasifikasyon yetersiz olabilir; yalancı dolum defektini başka düzlemde ve daha iyi opasifiye kesitlerde doğrulayın.
• Kronik trombozda belirgin ven genişlemesi olmayabilir; küçük kollateral kanalları ve böbrek boyut kaybını da arayın.

Kendini dene

1. Nefrotik sendromlu hastada böbrek büyümüş, nefrogram azalmış ve renal vende geniş dolum defekti var. Tanı nedir?

   • Renal ven trombozu
   • Renal arter anevrizması
   • Akut piyelonefrit
   • Renal hücreli karsinom
   Cevabı göster

   Renal ven trombozu. Genişlemiş renal ven içindeki dolum defekti ve eşlik eden konjestif nefrogram renal ven trombozunu destekler. Arter anevrizması arteriyel sakküler genişlemedir; piyelonefrit parankim/ürotelyum inflamasyonu yapar; karsinom renal parankimde kitle olarak görülür.

2. Renal kitleye bitişik ven içi doku kontrastlanıyor ve VKİ'ye uzanıyor. En olası intravasküler içerik hangisidir?

   • Tümör trombüsü
   • Bland trombüs
   • Karışım artefaktı
   • Nutcracker fenomeni
   Cevabı göster

   Tümör trombüsü. Bland trombüs damar duvarı sınırları içinde kalır ve tümör trombüsüne göre farklı kontrastlanma gösterir; karışım artefaktı anatomik devamlılık oluşturamaz; Nutcracker fenomeni ise lümen içi doku yapmaz.

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 6 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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