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Akut-kronik subdural hematom

Acute-on-chronic subdural hematoma

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Akut-kronik subdural hematom: yayımlanmış olgu görüntüsü, aksiyel kesit

5 adım

Görüntü: Mallah S, Owda F, Hamayel H ve ark., “Successful Management of Acute Promyelocytic Leukemia in a Patient Who Presented With Acute Ischemic Stroke on Top of Subdural Hematoma.” 2023, Figure 1. PMC10576595 · doi:10.7759/cureus.45243 · CC BY 4.0. Değişiklik: kırpıldı, yeniden boyutlandırıldı, odak işaretleri eklendi.

Özet

Akut-kronik subdural hematom, önceden var olan kronik subdural koleksiyon içinde daha yeni kan ürünlerinin birikmesiyle oluşan karma yaşlı kanama görünümüdür. Kontrastsız BT, hipodens veya izodens arka plan içinde yeni hiperdens bileşeni, seviyelenmeyi ve toplam kitle etkisini gösterir. Akut-kronik subdural hematomda düşük yoğunluklu koleksiyonun altında yüksek yoğunluklu bir tabaka ve sıvı-kan seviyesi görülebilir. Yeni bileşeni ve iki taraflı basıyı atlamak, hastadaki ani klinik değişimi açıklayan önemli görüntüleme bulgusunu gözden kaçırabilir.

Faz ve pencere

Kontrastsız tanısal
BOS'a yakın hipodens ya da kortekse izodens subdural koleksiyon içinde hiperdens yeni kan alanı, tabakalanma veya farklı yoğunluklu odacıklar görülebilir. Tanısal değerlendirme kontrastsız BT'de yapılır; sabit HU eşiğiyle yaş tayini yapılamaz ve kontrastlı faz rutin tanı için gerekli değildir.

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

BT bulguları

  • Kronik görünümlü hilal koleksiyonun içinde, kenarında veya bağımlı bölümünde belirgin hiperdens yeni kan bileşeni bulunabilir.
  • Sıvı-kan seviyesi veya düşük yoğunluklu koleksiyonun altındaki hiperdens tabaka, akut-kronik subdural hematomda yakın dönem kanamayı düşündürebilir.
  • Aynı koleksiyonun farklı kompartımanları hipodens, izodens ve hiperdens görünebilir.
  • Akut-kronik subdural hematom koleksiyonunda hacim artışı ve kitle etkisiyle orta hat kayması ve lateral ventriküllere bası görülebilir.
  • Bilateral hematomlarda toplam kitle etkisi subfalsin herniasyona yol açabilir; singulat girus falksın altına yer değiştirir ve ön serebral arter basısı gelişebilir.
  • Eşlik eden kontüzyon, subaraknoid kan veya kalvaryal kırık, yeni travmanın başka intrakraniyal izlerini gösterebilir.
  • BT'de hematomun maksimum genişliği ve orta hat kayması ayrı ayrı ölçülüp kaydedilmelidir.

Normalde

Normal lateral ventrikül gövdesi düzeyinde konveksite boyunca ekstraaksiyel hilal, yoğunluk tabakaları veya kortikal yüzeye bası bulunmaz; ventriküller ve sulkuslar iki tarafta dengelidir. Karşılaştırmada düşük yoğunluklu koleksiyonun yayılımını ve altındaki yüksek yoğunluklu bileşeni ayrı değerlendir; ardından koleksiyonun oluşturduğu kitle etkisini, örneğin orta hat kaymasını, incele.

Normal BT ile kıyasla

Aynı bölgenin, kaynak veri setinde patoloji içermediği belirtilen bir BT incelemesini kesit kesit kaydırın; organ sınırlarını açarak anatomiyi hasta görüntüsüyle karşılaştırın. Küçük rastlantısal bulgular tümüyle dışlanmamıştır.

Kaynak: TotalSegmentator v2.01 veri seti (Wasserthal ve ark., Radiology: Artificial Intelligence 2023), CC BY 4.0, vaka s0103; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Tek başına kronik subdural hematom
hipodens/izodens koleksiyon ve membranlar bulunur, yeni odak hiperdens olmayabilir.
Tek akut subdural hematom
koleksiyon genel olarak hiperdensdir; kronik sıvı arka planı veya belirgin membranlaşma yoktur.
Subdural higroma içinde akut kan
BOS yoğunluklu sıvı içine kan karışabilir; önceki görüntü ve membran görünümü kronik hematomdan ayırmaya yardım eder.
Düşük yoğunluklu bileşenin altında keskin sınırlı yüksek yoğunluklu tabaka, ayrılmış tip akut-kronik subdural hematomda yakın dönem kanamayı düşündürür.

Tuzaklar

  • Karışık yoğunluklu subdural koleksiyonların görünümü tekrarlayan kanama epizotlarını yansıtabilir.
  • Yeni hiperdens bileşen, sıvılaşmış hematom içinde tabaka, düzensiz sınırlı pıhtı veya nodüler odaklar şeklinde görülebilir; koleksiyonun tamamını tek yoğunlukta değerlendirme.
  • Bilateral hematomlarda her iki hemisferdeki kitle etkisi ve ventriküler bası ayrı ayrı değerlendirilmelidir.
  • Akut travma sonrası karışık yoğunluklu subdural koleksiyon akut-kronik hematomla uyumlu olabilir; yoğunluk görünümü tekrarlayan kanama epizotlarını yansıtabileceğinden kanın yaşı tek başına BT görünümünden kesin belirlenemez.

Kendini dene

  1. Daha önce var olan kronik subdural hematom içinde kontrastsız BT'de hipodens ve hiperdens bileşenler ile orta hat kayması görülmüş. En olası tanı nedir?

    Cevabı göster

    Akut-kronik subdural hematom. Akut-kronik subdural hematom, önceden var olan hematom üzerine yeni kanama eklenmesidir. Kontrastsız BT'de akut ve kronik subdural hematom bileşenleri birlikte görülebilir.

  2. Akut-kronik subdural hematomun ayrılmış tipinde kontrastsız BT'de hangi görünüm beklenir?

    Cevabı göster

    Düşük yoğunluklu koleksiyonun altında keskin sınırlı yüksek yoğunluklu tabaka. Ayrılmış tipte yoğunluğu yüksek bölümün altta ve düşük yoğunluklu bölümden belirgin bir sınırla ayrılmış görünmesi, yeni kanamayı düşündürür.

İlgili konular

Kaynaklar

Bu sayfadaki 35 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 19 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.