Dural venöz sinüs trombozu

Özet

Baş ağrısı, nöbet, fokal defisit veya kafa içi basınç artışı bulgularıyla başvuran hastada dural sinüs trombozu, venöz drenajı bozarak ödem ve kanamalı infarkt oluşturabilir. Kontrastsız BT trombüsü bazen hiperdens gösterir; ancak normal görünmesi trombozu dışlamaz ve tanısal değerlendirmede BT venografi lümen dolumunu doğrudan gösterir. Superior sagittal sinüs, torcula, transvers ve sigmoid sinüsler kesintisiz izlenerek trombüsün uzanımı haritalanmalıdır. Tanının atlanması venöz konjesyonun ilerlemesine, kanamalı infarkt ve kitle etkisinin gözden kaçmasına yol açabilir.

Faz ve pencere

Kontrastsız tanısal

Akut pıhtı superior sagittal, transvers veya sigmoid sinüs içinde normal venöz kana göre hiperdens görünebilir; ödem, sulkus silinmesi, hemorajik venöz infarkt veya konveksite subaraknoid kanaması eşlik edebilir. Bu kontrastsız seri başlangıç değerlendirmesidir; normal görünmesi venöz sinüs trombozunu tek başına dışlamaz.

Gecikmiş tanısal

Kontrastlı venografide venöz klotsun doğrudan tespitini sağlayan temel bulgu, sinüs lümeninde görülen dolum defektidir. Posterior superior sagittal sinüste üçgensel hiperdensite 'delta işareti' olarak adlandırılır ve bu bölgedeki trombozu temsil eder.

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

BT bulguları

• Kontrastlı venografide superior sagittal sinüste doğrudan bulgu, klotsun yerini gösteren venöz dolum defektidir.
• Posterior superior sagittal sinüste üçgensel hiperdensite 'delta işareti' olarak adlandırılır ve bu bölgedeki trombozu temsil eder.
• Transvers-sigmoid sinüs opaklaşmaması — tek taraflı hipoplazi varyantını dışlamak için karşı sinüs kalibresi, sigmoid oluk ve juguler bulbus devamlılığıyla birlikte incelenir.
• Akut hiperdens sinüs — kontrastsız seride pıhtı sinüs lümenini çevre parankimden daha yoğun gösterir; hematokrit yüksekliği benzer yoğunluk yaratabilir.
• Kollateral venöz belirginleşme — falx, tentoryum veya kortikal venlerde belirgin kontrastlanma, çıkış engelinin eşlikçisi olabilir.
• Venöz ödem ve hemorajik infarkt — arteriyel sulama alanına uymayan kortikal-subkortikal hipodensite, şişme ve peteşiyel ya da parankimal kanama.
• Torcula ve düz sinüs uzanımı — birleşme bölgesi ile derin sistem çıkışındaki opaklaşma kusuru trombüsün yaygınlığını belirler.

Normalde

Normal kontrastlı venografide superior sagittal sinüs, torcula, iki transvers sinüs ve sigmoid sinüsler kesintisiz, lümen boyunca homojen opaklaşır; sağ-sol çap farkı tek başına tıkanıklık değildir. Kontrastsız seride sinüs yoğunluğunu komşu korteks ve hematokrit bağlamında, venografide ise karşı taraf, kemik oluk ve juguler bulbusa devamlılıkla kıyaslayın.

Ayırıcı tanı

Konjenital transvers sinüs hipoplazisi

küçük kemik oluğu ve juguler foramen/bulbus ile aynı tarafta gelişimsel küçüklük bulunur; karşı sinüs genellikle baskındır.

Araknoid granülasyon

çoğunlukla fokal, düzgün sınırlı, sinüs duvarına oturan dolum defektidir; sinüsü genişletmez ve çevresinde akım devam eder.

Yüksek hematokrit

kontrastsız BT'de birden fazla damar ve sinüs benzer biçimde yoğunlaşabilir; venografide gerçek intraluminal dolum kusuru oluşmaz.

Akut arteriyel infarkt

belirli arter alanına uyan erken hipodensite ve olası arter tıkanıklığı vardır; venöz sinüs defekti beklenmez.

İntrakraniyal hipotansiyon

yaygın dural kalınlaşma ve kontrastlanma yapabilir, fakat sinüs lümeninde trombüs dolum kusuru yoktur.

Tuzaklar

• Tek taraflı transvers sinüsün ince olması sık anatomik varyanttır; tromboz demeden önce ipsilateral sigmoid oluk ve juguler çıkışın küçük olup olmadığını kontrol edin.
• Arteriyel fazda sinüsün erken veya düzensiz opaklaşması yavaş akım gibi görünebilir; venöz zamanlı venografiye dayanmadan açıklık ya da tromboz kararı vermeyin.
• Yüksek hematokrit sinüsü yalancı hiperdens gösterebilir; kontrastsız dansite bulgusunu venografideki gerçek dolum kusuruyla doğrulayın.
• Normal kontrastsız BT venöz trombozu dışlamaz; doğrudan venografi veya MR venografi gerektiren klinik kuşkuyu görüntüde kapatmayın.

Kendini dene

1. Kontrastsız BT'de posterior superior sagittal sinüste üçgensel hiperdensite ('delta işareti') görünüyor. En olası bulgu nedir?

   • Dural sinüs trombozu
   • Araknoid granülasyon
   • Meningiom
   • Yüksek hematokrit
   Cevabı göster

   Dural sinüs trombozu. Üçgensel hiperdensite delta işareti olarak bilinir ve trombozu temsil eder. Araknoid granülasyon fokal ve düzgün sınırlıdır; meningiom dural tabanlı kitle olabilir; hematokrit artışı kontrastsız yoğunluğu etkiler.

2. Sol transvers sinüs ince; aynı tarafta sigmoid oluk ve juguler bulbus da küçük, lümen düzgün opaklaşıyor. En olası yorum nedir?

   • Gelişimsel hipoplazi
   • Akut sinüs trombozu
   • Venöz sinüs duplikasyonu
   • Araknoid granülasyon
   Cevabı göster

   Gelişimsel hipoplazi. Sinüsle birlikte kemik oluğun ve juguler çıkışın küçük olması gelişimsel hipoplaziyi destekler. Akut trombozda lümen dolum kusuru veya opaklaşmama beklenir; diğer seçenekler bu bütün taraflı küçüklük ilişkisini açıklamaz.

İlgili konular

• Kortikal veya derin serebral ven trombozu
• Venöz konjesyon ve venöz infarkt
• Sinüs trombozu taklitçileri ve normal varyantlar

Kaynaklar

Bu sayfadaki 40 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 4 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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