Yabancı cisim aspirasyonu

Özet

Özellikle küçük çocukta ani öksürük veya boğulma öyküsü sonrasında bronşa kaçan cisim, kısmi kapak mekanizmasıyla distal akciğerde hava hapsine, tam tıkanmada ise atelektaziye yol açabilir. BT, radyolüsen cisimleri doğrudan veya bronş kesilmesi, distal hava hapsi gibi ikincil bulgularla gösterebilir; ancak negatif görüntüleme yüksek klinik şüphede tanıyı kesin olarak dışlamaz. Cisim ve bronş düzeyinin gösterilmesi bronkoskopik değerlendirmeyi yönlendirir. Tanının gecikmesi tekrarlayan enfeksiyon, kalıcı bronş hasarı veya akut hava yolu tıkanmasıyla sonuçlanabilir.

Faz ve pencere

Kontrastsız tanısal

İnce kesit akciğer penceresinde bronş lümenindeki yabancı cisim doğrudan seçilebilir; düz grafide görünmeyen cisimde ani bronş kesilmesi, tek taraflı lobar düşük atenüasyon ve damar işaretlerinde seyrelme dolaylı bulgulardır. Kontrast, cismi veya hava hapsini göstermek için gerekmez.

Önerilen pencereler: Akciğer (G 1500 / M -600), Mediasten (G 350 / M 50).

BT bulguları

• Endobronşiyal dolum defekti — ana, lober veya segmental bronş lümeninde hava ile çevrili yabancı materyal.
• Ani bronş kesilmesi — cismin proksimalinde havalı bronşun ani sonlanması; ardışık kesitlerde tıkanma düzeyini bulun.
• Tek taraflı hava hapsi — etkilenen lob ekspiryumda da düşük atenüasyonunu ve genişlemesini korur.
• Azalmış distal vasküler işaret — hiperinflasyonlu lobda damarlar karşı taraftaki aynı düzeye göre seyrek ve ince görünür.
• Obstrüktif atelektazi — tam tıkanmada distal lob küçülür, opaklaşır ve fissür tıkanmaya doğru yer değiştirir.
• Tıkalı bronşun distalinde havasız kalan parankim atelektazi yapar; bu durum muküs tıkacı ile benzeşebilir ve uzun süreli tutulumda bronşektazi ile fibrotik değişikliklere yol açabilir.
• Mediastinal yer değiştirme — belirgin tek taraflı aşırı havalanma karşı hemitoraksa itebilir; eşlik eden hacim kaybı yönü tersine çekebilir.

Normalde

Normal bronşlar trakeadan hilusa doğru dallanırken lümen açıklığını korur; her iki akciğer lobunda damar yoğunluğu ve ekspiryumla hacim azalması kabaca simetriktir. Aynı seviyedeki karşı lobla bronş lümenini, parankim atenüasyonunu ve damar sıklığını kıyaslayın; tek taraflı ekspiryumda sönmeyen lob kapak tipi tıkanmayı destekler.

Ayırıcı tanı

Mukus tıkacı

bronşu tamamen tıplayarak yabancı cisme benzer şekilde atelektazi yapabilir; bronkoskopik temizlenmesinden sonra akciğer hızla genişler.

Bronşiyal atrezi

tipik olarak distal bronkosel ve segmental hiperinflasyon birliktedir; edinilmiş aspirasyon öyküsü aranmaz.

Enfeksiyöz bronşiolit, yabancı cisim aspirasyonu gibi hava yollarını tutabilen patolojiler arasında ayırıcı tanıda değerlendirilir.

Endobronşiyal kitle

bronş duvarına bağlı yumuşak doku ve kalıcı daralma yapabilir; yaş ve seri görüntüleme bulguları önemlidir.

Tuzaklar

• Yabancı cisimlerin çoğu radyolüsen olduğundan yalnızca doğrudan cisim görünümünü aramak yanlış negatifliğe yol açar; bronş kesilmesi ve distal lob asimetrisini de izleyin.
• Tek taraflı hiperlüsensi tek başına aspirasyonu kanıtlamaz; çekim fazı, eşlik eden doğumsal hiperinflasyon ve karşı tarafın ekspiryum derecesini karşılaştırın.
• Mukus tıkacı veya plastik bronşit cast'ı, yabancı cisim aspirasyonu ve post-obstrüktif hasarı taklit edebilir; kesin ayırım için bronkoskopi gereklidir.

Kendini dene

1. Ani boğulma öyküsü olan çocukta sol üst lob bronşunda endobronşiyal dolum defekti ve distalde hava hapsi görülüyor. En olası tanı nedir?

   • Yabancı cisim aspirasyonu
   • Bronşiyal atrezi
   • Mukus tıkacı
   • Bronkojenik kist
   Cevabı göster

   Yabancı cisim aspirasyonu. Ani boğulma öyküsüyle birlikte bronş içindeki dolum defekti ve aynı lobdaki distal hava hapsi yabancı cisim aspirasyonunu destekler. Mukus tıkacı benzer tıkanma yapabilse de öykü ve materyalin görünümü birlikte değerlendirilir; bronşiyal atrezide doğumsal bronkosel, bronkojenik kistte ise dıştan bası beklenir.

2. Bir bronş tıkanıklığının distalinde lob küçülmüş ve opaklaşmış. Bu görünüm en çok neyi düşündürür?

   • Tam bronş tıkanması
   • Kapak tipi hava hapsi
   • Konjenital lober hiperinflasyon
   • Pulmoner sekestrasyon
   Cevabı göster

   Tam bronş tıkanması. Tam tıkanma distal havanın emilmesiyle atelektazi yapabilir. Kapak tipi mekanizmada lob geniş ve hiperlüsens olur; lober hiperinflasyon bronşta yabancı cisim olmadan gelişir, sekestrasyon ise sistemik arterle beslenir.

Bu konunun yer aldığı turlar

• Çocukta acil BT

İlgili konular

• Bronşiyal atrezi ve bronkosel
• Konjenital lober hiperinflasyon (konjenital lober amfizem)

Kaynaklar

Bu sayfadaki 35 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 6 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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