Epidural hematom

Özet

Epidural hematom, travma sonrası kalvaryumun iç tabulası ile dura arasında kan birikmesidir; özellikle temporal/temporopariyetal bölgede kırıkla birlikte görülebilir. Travmatik akut epidural hematomlar genellikle orta meningeal arter veya venöz sinüs yaralanmaları sonucu oluşur ve kitle etkisi yaratmaya eğilimlidir. Kontrastsız beyin BT koleksiyonun biçimini, yayılımını ve beyin üzerindeki basıyı gösterir; kemik penceresi eşlik eden kırığı araştırır. Hematomun erken ya da sınırlı görünmesi genişleyen kanama ve herniasyon bulgularını dışlamaz.

Faz ve pencere

Kontrastsız tanısal

Dura ile kalvaryum iç tabulası arasında, travma sonrası intrakraniyal kanamada karakteristik olarak hiperdens ve bikonveks şekilli koleksiyon izlenir; travma sonrası intrakraniyal kanamanın değerlendirilmesinde kontrastsız BT altın standart olup tanı için ek kontrast uygulanması gerekmez. Travma sonrası intrakraniyal kanamanın değerlendirilmesinde kontrastsız BT altın standart olup tanı için ek kontrast uygulanması gerekmez.

Önerilen pencereler: Beyin (G 80 / M 40), Subdural (G 200 / M 75), Kemik (G 1800 / M 400).

BT bulguları

• Epidural hematomlar karakteristik olarak bikonveks şekilli ekstraaksiyel kanamalar olup kafa içi kitle etkisi oluşturabilir.
• Kontrastsız BT, travma sonrası intrakraniyal kanamanın ve eşlik eden kırık hattlarının tanımlanmasında altın standart olup koleksiyonun yayılımı ve kafa içi yapılar üzerindeki baskı etkisi değerlendirilmelidir.
• Bilgisayarlı tomografide kırık hattları ve komşu damar yaralanmalarına işaret eden kemik lezyonları epidural hematom açısından değerlendirilmelidir.
• Hematom içindeki swirl sign (girdap işareti), kanamanın hızlı ilerlediğini ve kötü prognoz riskinin arttığını gösteren bir bulgu olarak değerlendirilir.
• Temporal lobun medial itilmesi, bazal sisternlerin daralması ve orta hat yapılarının karşıya ötelenmesi bası etkisini gösterir.
• Arka çukur epidural hematomları, bu bölgenin kısıtlı hacmi nedeniyle beyin sapı ve solunum merkezleri üzerinde ciddi bası etkisi oluşturabilir.

Normalde

Travma sonrası BT incelemelerinde, intrakraniyal kanama veya kırık gibi patolojik bulguların yokluğu normal anatomik yapıların korunmuş olduğunu gösterir. Travma sonrası BT incelemelerinde, kanamanın genişleme eğilimi ve komşu kafa içi yapılar üzerindeki baskı etkisi seri görüntülemelerle takip edilmelidir.

Ayırıcı tanı

Travmatik ekstraaksiyel kanamaların ayırıcı tanısında bilgisayarlı tomografi, kanamanın yerini, boyutunu ve gelişebilecek kitle etkisi riskini değerlendirmek için gereklidir.

Hemorajik kontüzyon ve diğer parankimal kanama tipleri arasında ayrım yapılırken, BT intrakraniyal kanamanın çeşitli nedenlerini ve varyant görünümlerini ortaya koymalıdır.

Kalvaryum altında oluşan ekstraaksiyel koleksiyonların ayırıcı tanısında bilgisayarlı tomografi, eşlik eden kafa kemiği kırıklarını, intrakraniyal kanamayı ve parankimal yaralanmaları değerlendirmek için kullanılır.

Ekstraaksiyel hiperdens lezyonların ayırıcı tanısında travmatik kanama dışındaki patolojiler de düşünülmeli ve bilgisayarlı tomografi ile kanama yoğunluğu ve kitle etkisi değerlendirilmelidir.

Tuzaklar

• BT görüntülerinde ekstraparenkimal kanama türlerinin ayırt edilmesi kritik olup, 'hemoraji' aktif süreç iken 'hematom' oluşan kan kütlelerini tanımladığından terminoloji dikkatle seçilmelidir.
• Arka çukur ve kranioservikal bölgede travmatik kanamaların değerlendirilmesinde çoklu düzlemli bilgisayarlı tomografi reformasyonları, lezyon saptanmasını ve tedavi edilebilir yaralanmaların erken tanısını kolaylaştırır.
• Swirl sign (girdap işareti), epidural hematomda progresyon ve kötü prognoz göstergesidir; ancak tek başına kesin bir cerrahi endikasyon olarak kabul edilmemelidir.

Kendini dene

1. Travma sonrası kafatası üstü konkaviteste, kemik kırığı hattının üzerinde yer alan bikonveks ve hiperdens bir koleksiyon saptanıyor. Bu radyolojik görünüm en çok aşağıdakilerden hangisini düşündürür?

   • Epidural hematom
   • Akut subdural hematom
   • Parankimal kontüzyon
   • Subaraknoid kanama
   Cevabı göster

   Epidural hematom. Kemik kırığı hattının üzerinde, dura ile kalvaryum arasında sınırlı kalan bikonveks ve hiperdens koleksiyon epidural hematom ile karakteristiktir. Akut subdural hematom sığırboynuzu şeklinde yayılır, kontüzyon parankim içindedir ve subaraknoid kanama girintilerde izlenir.

2. Akut epidural hematom görüntüsünde hiperdens kanama içinde hipodens girdap benzeri alan (swirl sign) izleniyor. Bu radyolojik işaret en çok aşağıdakilerden hangisini gösterir?

   • Kanamanın aktif ilerlediğini ve kötü prognoz riskini artırdığını
   • Lezyonun kronik ve kalsifi olduğunu
   • BOS sızıntısı sonucu oluşan psödokisti
   • Lezyonun lipomatoz yapıda olduğunu
   Cevabı göster

   Kanamanın aktif ilerlediğini ve kötü prognoz riskini artırdığını. Swirl sign, epidural hematomda aktif kanama ve hızlı progresyonun radyolojik göstergesidir ve kötü klinik seyir ile ilişkilendirilir.

Bu konunun yer aldığı turlar

• Acil BT'de kaçırılmaması gereken bulgular
• Kafa travması ve intrakraniyal kanama

İlgili konular

• Akut subdural hematom

Kaynaklar

Bu sayfadaki 34 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 22 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez. İçerik yapay zekâ destekli bir süreçle güncel literatüre göre cümle cümle kaynaklarla karşılaştırıldı, ancak uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.