Çocukta böbrek travması

Özet

Çocuklarda böbreğin görece büyük olması, perirenal yağ dokusunun daha az olması ve kaburga kafesinin daha esnek olması künt travmada renal yaralanmaya yatkınlığı artırır. Stabil hastada intravenöz kontrastlı BT parankim, damar pedikülü ve komşu retroperitoneumu gösterir; gecikmiş görüntüler toplayıcı sistem kaçağını ortaya çıkarabilir. Hematüri olmaması böbrek hasarını dışlamaz ve majör damar yaralanması belirgin hematüri yapmayabilir. Üreteropelvik bileşke kopması, devaskülarizasyon veya idrar kaçağının atlanması böbrek işlev kaybını ve geç komplikasyonları geciktirebilir.

Faz ve pencere

Arteriyel tanısal

Renal arter dallarında kesilme, tromboz veya aktif kontrast kaçağı; segmental arter tıkanmasında beslenme alanına uyan kama biçimli kontrastlanmayan parankim aranır.

Portal tanısal

Renal parankim veya pelvis laserasyonuna üriner ekstravazasyon eşlik edebilir; gecikmiş BT görüntüleri kaçağın değerlendirilmesine yardımcı olur. Renal pedikül avulsiyonu ve medial kutupta devaskülarizasyon, ağır renal travmada görülebilir.

BT ürografi tanısal

Gecikmiş boşaltım görüntülerinde kontrastlı idrar renal pelvis dışına sızarak yarık boyunca veya perirenal alanda birikir; medial ekstravazasyon üreteropelvik bileşke yaralanmasını düşündürür.

Önerilen pencereler: Batın (G 400 / M 50), Anjiyo (G 600 / M 150).

BT bulguları

• Renal parankim veya pelvis laserasyonuna üriner ekstravazasyon eşlik edebilir; gecikmiş BT görüntüleri kaçağın değerlendirilmesine yardımcı olur.
• Travma sonrası izlemde subkapsüler koleksiyon görülebilir ve sürebilir.
• Renal travmada BT’de perirenal hematom görülebilir; pararenal hematom da eşlik edebilir.
• Renal travma sonrasında alt pol infarktı görülebilir.
• Renal travmada ana renal arter yaralanması ve renal hilus avulsiyonu görülebilir.
• Üriner ekstravazasyon — gecikmiş BT görüntülerinde toplayıcı sistem yaralanmasına eşlik eden kontrast kaçağının izlenmesi.
• Üreteropelvik bileşke yaralanmasında gecikmiş BT görüntüleri üriner ekstravazasyonu değerlendirmeye ve yaralanmanın atlanmasını önlemeye yardımcı olur.

Normalde

Travma BT’sinde renal morfolojiyi, böbrek kaynaklı kanamayı ve ürinoma varlığını değerlendirin. Gecikmiş BT’de üriner ekstravazasyonu ve üreterde kontrast bulunup bulunmadığını değerlendirin.

Ayırıcı tanı

Renal travmanın değerlendirilmesinde enfeksiyöz ve vasküler renal nedenler de ayırıcı tanıda yer alır.

Böbrek kontüzyonu, çocuklarda künt travma sonrası görülebilen renal yaralanma biçimlerinden biridir.

Üreteropelvik bileşke obstrüksiyonu önceden var olabilir ve düşük enerjili travma sonrası tanınabilir.

Dalak veya karaciğer kaynaklı kan

hematom böbreği dıştan sarabilir; renal parankim ve damarlar korunmuşsa komşu solid organı izleyin.

Tuzaklar

• Renal travma BT’sinde damar kaynaklı bulguları ve infarktı değerlendirirken arteriyel ve venöz faz görüntülerini birlikte inceleyin.
• Perirenal sıvıyı hematom kabul edip gecikmiş fazı atlama; toplayıcı sistem yaralanması için kontrastlı idrarın dağılımını izle.
• Gecikmiş BT’de üreterde kontrast bulunup bulunmadığını değerlendirin; bu bulgu gözlem grubunda daha düşük müdahale olasılığıyla ilişkili bulunmuştur.
• Normal idrar tahlilini dışlama ölçütü sayma; görüntüde damar pedikülü, parankim ve pelvis hasarını doğrudan değerlendir.

Kendini dene

1. S2’deki çocuklarda grade IV renal travma ve üriner ekstravazasyon çalışmasında kaç üreteropelvik bileşke rüptürü bildirilmiştir?

   • 2
   • 5
   • 7
   • 14
   Cevabı göster

   5. Çalışmanın 19 olguluk kohortunda 5 üreteropelvik bileşke rüptürü bildirilmiştir.

2. Gecikmiş BT görüntüsünde kontrastlı idrar renal pelvisin medialine yayılıyor, distal üreter seçilmiyor. Yaralanma nerede?

   • Üreteropelvik bileşke
   • Mesane kubbesi
   • Renal korteks
   • Dalak hilusu
   Cevabı göster

   Üreteropelvik bileşke. Mediale yönelen idrar kaçağı ve distal üreterin opaklaşmaması bileşke ayrılmasını düşündürür. Mesane yaralanması pelvik ekstravazasyon yapar; korteks laserasyonu kendi parankiminde kalır; dalak hilusu üriner sistem değildir.

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 20 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.