Üst hava yolunda yabancı cisim BT bulguları

Özet

Üst hava yolu yabancı cismi küçük çocuklarda ani öksürük, boğulma veya ses değişikliğiyle ortaya çıkabilir; organik maddeler radyolüsent olduğundan doğrudan görülmeyebilir. Üst hava yolu tıkanması kuşkusu acil ve potansiyel olarak yaşamı tehdit eden bir durumdur; hızlı değerlendirme gerekir ve BT gibi kesitsel incelemeler karmaşık olgularda kullanılabilir. Larenks ya da trakeadaki tıkanma, distal bronş yabancı cismine göre daha hızlı hava yolu tehdidi yaratabilir. Cismi ararken glottik açıklığı ve eşlik eden duvar ödemini ihmal etmek obstrüksiyon derecesinin eksik aktarılmasına neden olur.

Faz ve pencere

Kontrastsız tanısal: Radyolüsent cisimler ilk BT değerlendirmesinde gözden kaçabilir; hava yolu yapılarının hedefli incelenmesiyle saptanabilir. İlk BT değerlendirmesi negatif olsa bile radyolüsent yabancı cisim şüphesi sürüyorsa hava yolu yapıları hedefli biçimde yeniden incelenmelidir; negatif BT yabancı cismi dışlamaz.

Önerilen pencereler G genişlik, M merkez; değerler Hounsfield birimi (HU)

Yumuşak dokuG 400 / M +40
AkciğerG 1500 / M −600
KemikG 1800 / M +400

BT bulguları

Supraglottik, glottik veya subglottik lümende hava sütununa oturan doğrudan yabancı cisim
Bazı cisimler radyopak olabilir; radyolüsent cisimler ise ilk BT incelemesinde gözden kaçıp hava yolu yapılarının hedefli değerlendirilmesiyle saptanabilir.
Lümen içindeki yabancı cisim radyolüsent ise BT’de gözden kaçabilir; bu nedenle ilk incelemenin negatif olması yabancı cismi dışlamaz.
Epiglot ve komşu supraglottik yapılarda ödem görülebilir.
Glottik açıklığın asimetrisi ve karşı vokal kord ile kıyaslandığında lümen deformasyonu
Cismin hipofarenkste kalması halinde özofagus girişi ve trakea lümeninin ayrı ayrı izlenmesi

Normalde

Normal larenks BT'sinde epiglot, ariepiglottik kıvrımlar ve vokal kordlar lümeni çevreleyen simetrik yumuşak doku yapılarıdır; hava sütunu kesintisiz izlenir. Aynı seviyedeki karşı duvarla lümen genişliğini ve şekli kıyasla; bir tarafa oturan cisim, ani daralma veya fokal duvar kalınlaşmasını ara.

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 s0622; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Sekresyon veya mukus tıkacı: lümende düşük/orta yoğunluklu şekilsiz materyal olabilir; belirgin duvar ödemi ve yabancı cisim öyküsüyle yorumlanır.
Larengeal ödem: lümen çevresinde yaygın, çoğu kez simetrik yumuşak doku kalınlaşması vardır; ayrı intraluminal cisim saptanmaz.
Krup kaynaklı subglottik daralma: subglottiste enfamasyon ve daralma görülür; lümen içinde cisim odaklanmaz.
Larengeal kitle veya kist: duvarla ilişkili, sabit yumuşak doku kitlesi lümene uzanır; akut aspirasyon başlangıcı tipik değildir.
Yutulmuş hipofaringeal/özofageal cisim: cisim posterior özofagus girişinde bulunur ve trakeal hava sütunundan ayrıdır.

Tuzaklar

Çoğu gıda kaynaklı yabancı cisim doğrudan radyopak değildir; BT'de görünmemesi, klinik şüphe varsa aspirasyonu dışlamaz.
Sekresyon ve hareket artefaktı lümen içinde yalancı cisim görünümü verebilir; ardışık ince kesitlerde şeklin devamlılığını çok düzlemli görüntülerle doğrula.
Baş hareketi ve yutkunma larenks düzeyinde yalancı asimetri oluşturabilir; cisim şüphesini sabit lümen kesilmesi ve çevresel doku etkisiyle destekle.
Çocukta iyonizan radyasyon maruziyeti önemlidir; BT'yi belirsiz, stabil olgudaki hedefli soruya göre kullan ve görüntü alanını gerekli anatomik düzeyle sınırla.
Güçlü klinik şüphede negatif ilk görüntüleme yabancı cismi dışlamaz; radyolüsent subglottik cisim, BT'de hava yolu yapılarının hedefli yeniden incelenmesi ve doğrudan laringoskopiyle saptanabilir.

Kendini dene

Boğulma öyküsü sonrası glottik düzeyde lümene yerleşmiş yabancı cisim ve boyun radyografisinde karşılık gelen radyopak lezyon görülebilir. En olası tanı nedir?
Cevabı göster
Larengeal yabancı cisim. Glottik düzeyde lümen içine uzanan odak yabancı cisim lehinedir. Glottik düzeyde yabancı cisim ve karşılık gelen radyopak lezyon bildirilmiştir.
BT'de cisim seçilmedi, ancak organik madde aspirasyonu şüphesi sürüyor. Bu bulgu nasıl yorumlanmalıdır?
Cevabı göster
Aspirasyonu dışlamaz. Başlangıç BT'si dahil görüntüleme incelemeleri sonuç vermese de daha sonra subglottik yabancı cisim saptanmıştır; bu nedenle negatif görüntüleme aspirasyonu dışlamaz.

İlgili konular

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 9 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.