Kısmen tromboze intrakraniyal anevrizma

Özet

Kısmen tromboze anevrizmada kese hacminin bir bölümü dolaşımla ilişkili kalırken geri kalanı organize trombüsle doludur; büyük ve dev lezyonlarda bu yapı komşu beyin dokusuna kitle etkisi yapabilir. Kontrastsız BT kanama, çevresel ödem ve duvar kalsifikasyonunu gösterir; BT anjiyografi ise kontrastlanan artık lümeni ana arterle ilişkilendirir. Sadece kontrastlanan lümenin ölçülmesi, kesede yer alan trombüs de dahil edildiğinde gerçek anevrizma boyutunu olduğundan küçük gösterebilir. Lezyon hematom veya tümör sanılırsa damar kökeni ve olası rüptür bulgusu gözden kaçabilir.

Faz ve pencere

Kontrastsız

Geniş kese çevresinde halka biçimli ya da eksantrik kalsifikasyon, hiperdens veya heterojen trombüs, komşu ödem ve kitle etkisi seçilebilir; artık lümen bu fazda güvenilir biçimde sınırlandırılamaz.

BTA tanısal

Ana arterle kesintisiz devam eden kontrastlı artık lümen, kese içindeki kontrast tutmayan mural trombüs bölümünden ayrılır; kaynak kesitler trombüsün lümen çevresindeki dağılımını ve ana damarla bağlantıyı gösterir.

Önerilen pencereler: Beyin (G 80 / M 40), Anjiyo (G 600 / M 150), Kemik (G 1800 / M 400).

BT bulguları

• Artık lümen — Ana arterden kese içine uzanan, damarla eş yoğunlukta kontrastlanan kanal; küçük lümen kese hacminin tamamını temsil etmeyebilir.
• Eksantrik mural trombüs — Kontrastlanmayan materyal, kontrastlı lümeni kısmen çevreler ve kese dış konturuna kadar uzanır.
• Lamelli trombüs — Kese içinde çeşitli yaşlarda trombüs birikimleri farklı yoğunlukta bölgeler oluşturabilir; BT'de bu katmanlı görünüm her zaman belirgin olmayabilir.
• Duvar kalsifikasyonu — Kese sınırında kavisli veya yarım halka biçimli yoğunluk artışı kemik penceresinde belirginleşir.
• Damar devamlılığı — Artık lümenin ana arterle birleştiği boyun, ardışık aksiyel kesitlerde ve ortogonal rekonstrüksiyonlarda izlenir.
• Kitle etkisi — Kese çevresindeki ödem, sulkus silinmesi, ventrikül basısı veya orta hat itilmesi tromboze kesenin parankimal etkisini gösterir.
• Eşlik eden kanama — Akut kan varsa subaraknoid sisternlerde, fissürlerde veya kese komşuluğunda hiperdens kan olarak değerlendirilir.

Normalde

Normal intrakraniyal arterlerin lümeni BTA'da kontrastla opaklaşarak damar anatomisini gösterir. Şüpheli kesede BTA lümen çapını gösterirken kontrastsız seri dış kese sınırını ve trombüs bileşenini ortaya koyar; iki serideki toplam lezyon genişliklerini karşılaştırın.

Ayırıcı tanı

Tromboze dev anevrizma

Dış kese çapı kontrastlanan lümenden belirgin geniştir; kalsifiye duvar veya komşu arterle devamlılık destekler.

İntraparenkimal hematom

Kan koleksiyonu arter lümeniyle kesintisiz bir boyun oluşturmaz; BTA'da kese içinde kontrastlanan kanal beklenmez.

Perianevrizmal neoplazi

Yumuşak doku kitlesi damar lümeniyle devam etmez; kontrastlanma solid dokuda olur ve damar yapısı çevresinden geçebilir.

Fuziform anevrizma

Vertebrobaziler arterlerden kaynaklanan fuzosakküler anevrizmada uzun damar segmenti tutulumu görülebilir.

Kalsifiye ekstra-aksiyel kitle

Kalsifikasyon kemik ya da dura komşuluğunda yerleşir, fakat kontrastlı kısmı bir intrakraniyal arterin artık lümeni olarak izlenmez.

Tuzaklar

• BTA'daki dar artık lümen anevrizma boyutu sanılabilir; kontrastsız BT'de duvar kalsifikasyonu ve trombüsün dış sınırını da kapsayarak toplam keseyi belirleyin.
• Komşu damar kesitleri parsiyel hacim etkisiyle kese içine giriyormuş gibi görünebilir; arter-kese devamlılığını ince kaynak kesitlerde ardışık olarak izleyin.
• Tromboze kese kontrastsız BT'de hematom veya kitle görünümü verebilir; BTA'da arterle eşzamanlı dolan artık lümeni özellikle arayın.
• Kontrastlanmayan trombüs, geniş anevrizmada tek başına tam tromboz anlamına gelmez; lümenin başka düzlemde veya kesenin farklı bölümünde devam edip etmediğini kontrol edin.

Kendini dene

1. BTA'da orta serebral arterden dolan küçük bir kanal, daha geniş ve kontrastlanmayan kese içinde izleniyor. En uygun yorum nedir?

   • Kısmen tromboze anevrizma
   • İntraparenkimal hematom
   • Serebral kavernom
   • Ekstra-aksiyel meningiom
   Cevabı göster

   Kısmen tromboze anevrizma. Arterle devam eden kontrastlı artık lümen ve bunun çevresindeki dolmayan kese bölümü kısmi trombozu destekler. Hematom ve kavernom arter lümeniyle bağlantılı kanal oluşturmaz; meningiom da arterden kese biçiminde genişlemez.

2. Kontrastsız seride kalsifiye duvar ve geniş kitle görülürken, BTA'da yalnızca küçük bir kontrastlı bölüm izleniyor. Hangi görüntüleme hatası en olasıdır?

   • Sadece açık lümeni ölçmek
   • Venöz sinüsü arter sanmak
   • Koroid pleksusu kitle saymak
   • Kemik penceresini beyin penceresi sanmak
   Cevabı göster

   Sadece açık lümeni ölçmek. Trombüs dış kese içinde yer kaplar; yalnız kontrastlanan kanalın ölçülmesi toplam anevrizma boyutunu küçümser. Hematom, kavernom ve meningiomlar ana damarla bağlantılı kontrastlı kanal oluşturmadığı için bu bulgu yalnızca kısmen tromboze anevrizma ile açıklanır; anevrizma içindeki trombüs ise kontrast dolumuna katılmayan durmuş kan yığınıdır.

İlgili konular

• Sakküler intrakraniyal anevrizma
• Fuziform anevrizma

Kaynaklar

Bu sayfadaki 38 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 5 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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