Üst ana toplardamar tıkanıklığı (VKS sendromu)

Özet

VKS obstrüksiyonu, baş-boyun ve üst ekstremitelerden kalbe venöz dönüşü bozar; tümör, tromboz, kateter veya fibrotik mediastinal hastalıkla gelişebilir. Kontrastlı toraks BT, VKS tıkanıklığını değerlendirmek ve tıkanıklığa bağlı gelişen kollateral ven yollarını göstermek için kullanılır. Azygos sisteminin anatomisi ve tıkanıklığa göre konumu, VKS sendromunda alternatif kan akış yollarının anlaşılmasında önemlidir. Mediastinal kitle VKS’yi sıkıştırarak obstrüksiyona yol açabilir; büyük mediastinal kitleye eşlik eden perikardiyal efüzyon da görülebilir.

Faz ve pencere

Venöz tanısal

Kontrastlı toraks BT, VKS obstrüksiyonunun kapsamını, brakiyosefalik ven bileşkesinin tutulumunu ve obstrüksiyonu aşan kollateral venöz yolları gösterebilir. Kontrastlı toraks BT, VKS obstrüksiyonunu ve obstrüksiyonu aşan kollateral venöz yolları gösterebilir.

Önerilen pencereler: Mediasten (G 350 / M 50), Anjiyo (G 600 / M 150), Yumuşak doku (G 400 / M 40).

BT bulguları

• Mediyaster kitle VKS ve brakiyosefalik venleri sıkıştırır veya kuşatır; tam oklüzyon veya daralma görülür.
• Kateter ilişkili tromboz veya organize trombüs, merkezi venöz yapılarında daralmaya veya oklüzyona yol açar.
• Azygos sistemi, superior ve inferior vena kava arasındaki önemli bir yolaktır ve tıkanıklıkta alternatif dönüş yolu sağlar.
• Azygos, hemiazygos, interkostal ve paravertebral venler genişleyerek toraks içi baypas ağı oluşturabilir.
• İç torasik ve lateral torasik venlerin belirginleşmesi uzun süreli santral venöz basınç artışını ve kollateral yolu destekler.
• Sağ ve sol brakiyosefalik venlerde daralma veya oklüzyon, santral venöz tıkanıklığın yayılımını gösterir.
• Mediastinal kitle, lenfadenopati, fibrotik yumuşak doku ya da damar içi cihaz obstrüksiyonun olası nedenini gösterir.
• Azygos arkı-VKS birleşkesini ve azygos sistemini değerlendirerek VKS obstrüksiyonunu aşan kollateral venöz yolları belirleyin.

Normalde

VKS obstrüksiyonunda obstrüksiyonu aşan birden çok kollateral venöz yol gelişebilir ve MDCT bu yolları gösterebilir.

Ayırıcı tanı

Kateter ilişkili tromboz, superior vena kava oklüzyonuna neden olabilir.

Malign dış bası

mediastinal kitle damar konturunu uzun segmentte iter ya da sarar; damar içine uzanım varsa invazyon eşlik edebilir.

Fibrotik mediastinit, enfeksiyöz, inflamatör veya malign nedenlerle mediastinum boyunca yaygın fibrozise ve yapı invazyonuna yol açabilir.

Konjenital VKS varyantı

damar seyri ve kalibresi farklıdır, ancak akut trombüs ya da çevresel kitle basısı göstermez.

Tuzaklar

• Yoğun kontrastın VKS'de oluşturduğu streak artefaktları BT görüntüsünü etkileyebilir.
• Azygos sisteminin anatomisi ve superior/inferior vena kava ile ilişkisi, alternatif venöz dönüş yollarının anlaşılması için önemlidir.
• Kollateral damarları küçük lenf nodu ya da mediastinal kitle sanma; venöz yapıların devamlılığını multiplanar görüntülerde izle.
• Merkezi venöz kateterlere bağlı tromboz, sıklıkla görülen ciddi bir komplikasyondur.

Kendini dene

1. Yüz ve boyun ödemi bulunan hastanın BT’sinde VKS oklüzyonu ve belirgin kollateral venler görülüyor. En olası tanı nedir?

   • VKS obstrüksiyonu
   • Pulmoner arter embolisi
   • Aort diseksiyonu
   • Perikardiyal efüzyon
   Cevabı göster

   VKS obstrüksiyonu. VKS oklüzyonu ve kollateral venlerin belirginleşmesi, VKS obstrüksiyonunu destekler. VKS obstrüksiyonu baş, boyun ve üst göğüsten venöz drenajı bozabilir; venöz tıkanıklıkta kollateral dolaşım gelişebilir ve tarif edilen bulgular VKS obstrüksiyonunu destekler.

2. Bir anatomik örnekte azygos ve hemiazygos venleri aşağıda birleşerek hangi damara drene olmuştur?

   • İnferior vena kava (VCI)
   • Pulmoner ven
   • Portal ven
   • Sol brakiyosefalik ven
   Cevabı göster

   İnferior vena kava (VCI). Kaynakta anlatılan anatomik örnekte azygos ve hemiazygos venleri aşağıda birleşerek VCI'ye drene olur.

İlgili konular

• Malign dış basıya bağlı VKS obstrüksiyonu
• VKS obstrüksiyonunda kollateral yollar
• Brakiyosefalik ven darlığı veya tıkanıklığı

Kaynaklar

Bu sayfadaki 35 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 26 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.