Çocukta karaciğer ve dalak travması

Özet

Künt karın travması geçiren çocukta karaciğer ve dalak, solid organ yaralanmalarının sık görülen hedefleridir. Hemodinamik olarak stabil hastada intravenöz kontrastlı abdomen-pelvis BT, laserasyonu, hematomu, damar hasarını ve hemoperitoneumu birlikte haritalar. Görüntüdeki anatomik derece klinik durumu tek başına belirlemez; aktif kanama ve eşlik eden yaralanmalar ayrıca tanımlanmalıdır. Damar hasarı veya karın içine ilerleyen kanamanın atlanması, gecikmiş kanama ve organ kaybı riskinin fark edilmesini geciktirebilir.

Faz ve pencere

Arteriyel tanısal

Karaciğer ve dalak dallarında kesilme, psödoanevrizma ya da parankim dışına taşan damar kontrastı aranır; aktif ekstravazasyon havuzlanır veya faz ilerledikçe biçim değiştirir.

Portal tanısal

Perihepatik, perisplenik oluklar ve pelviste kan dansiteli sıvı izlenebilir.

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

BT bulguları

• Karaciğer laserasyonu kontrastlı BT ile hipodens yarık veya kapsül uzantısı olarak değerlendirilir; spesifik boyutsal kriterler bu kaynaklarda tanımlanmamıştır.
• Dalak laserasyonu — dalak içinde düzensiz hipodens çatlak; hilusa uzanan çatlak damar hasarıyla birliktelik gösterebilir.
• Subkapsüler hematom travma BT'sinde kapsül altı kan koleksiyonu olarak izlenir; spesifik hilal biçimli görünüm detayları bu kaynaklarda yer almamaktadır.
• Aktif kontrast ekstravazasyonu — damar havuzuna benzemeyen, parankim dışına yayılan kontrast odağı; fazlar arasında büyüme veya şekil değişikliği gösterir.
• Travmatik psödoanevrizma — arteriyel fazda damar kontrastına eş dansiteli, sınırlı yuvarlak odak.
• Travma sonrası intraperitoneal sıvı BT ile yaygın olarak tespit edilir; bağımlı bölgelerdeki pıhtılaşmaya bağlı densite değişimleri bu kaynaklarda detaylandırılmamıştır.

Ölçütler ve sınıflamalar

AAST 2018 karaciğer yaralanma ölçeği

2018 AAST güncellemesine göre karaciğer yaralanmaları I'dan V'e kadar derecelendirilir; spesifik ölçüm eşikleri resmi ölçek dokümanında tanımlanır. 2018 ölçeğinde VI. derece yoktur.

AAST 2018 dalak yaralanma ölçeği

2018 AAST güncellemesine göre dalak yaralanmaları I'dan V'e kadar derecelendirilir; spesifik ölçüm eşikleri resmi ölçek dokümanında tanımlanır. 2018 AAST dalak yaralanma ölçeği; subkapsüler hematom, intraparenkimal hematom, laserasyon ve aktif kanama bulgularına göre I’dan V’e kadar detaylı bir şekilde sınıflandırır.

Normalde

BT yorumlamasında organ bütünlüğü, vasküler devamlılık ve bağımsız sıvı odakları değerlendirilir; spesifik anatomik kıyaslama protokolleri bu kaynaklarda yer almamaktadır.

Ayırıcı tanı

Perfüzyon farklılığı

kama biçimli düşük kontrastlanma vardır, ancak kapsüle uzanan keskin yarık veya çevresel kan eşlik etmeyebilir.

Dalak aksesuarı

dalakla aynı dansite ve kontrastlanmayı gösteren, hilus yakınında düzgün sınırlı nodüldür.

Fokal yağlanma veya yağdan korunmuş alan

karaciğer parankim kontrastından farklı dansite gösterir; kitle etkisi ve travmatik çevre kanaması beklenmez.

Basit kist

düzgün sınırlı, sıvı atenüasyonlu ve kontrastlanmayan odak; travmatik yarık biçimi göstermez.

Tuzaklar

• Arteriyel fazda yamalı dalak kontrastlanmasını laserasyon sanma; portal fazda kalıcı parankim kusuru olup olmadığını kontrol et.
• Psödoanevrizmayı aktif ekstravazasyonla eşitleme; sınırlı yuvarlak odak fazlar arasında sabit kalabilir, ekstravazasyon ise çevreye yayılır.
• Serbest sıvıyı solid organ yaralanmasına otomatik bağlama; bağırsak-mezenter, böbrek ve pelvis yaralanmalarını da tarayın.
• Düşük dereceli parankim bulgusunun yanında hilar damar hasarını veya kapsül dışına taşmış kanı gözden kaçırma; damar ve serbest sıvı pencerelerini ayrıca gözden geçir.

Kendini dene

1. Künt travmalı çocukta portal fazda dalağı kesen hipodens yarık ve perisplenik kan var. En olası tanı nedir?

   • Dalak laserasyonu
   • Dalak infarktı
   • Aksesuar dalak
   • Dalak kisti
   Cevabı göster

   Dalak laserasyonu. Parankimi kesen düzensiz yarık ve çevresindeki kan, travmatik laserasyonu destekler. İnfarkt kama biçimli olsa da damar dağılımına uyar ve perisplenik kan beklenmez; aksesuar dalak ile kist düzgün sınırlı odaklardır.

2. Arteriyel seride dalak içinde yuvarlak, damar gibi kontrastlanan ve sonraki fazda sınırlı kalan odak görülüyor. Bu nedir?

   • Psödoanevrizma
   • Aktif ekstravazasyon
   • Parankim laserasyonu
   • Subkapsüler hematom
   Cevabı göster

   Psödoanevrizma. Damarla eş kontrastlanan sınırlı yuvarlak odak psödoanevrizmayı düşündürür. Ekstravazasyon fazlar arasında yayılır; laserasyon çizgisel parankim kusuru, subkapsüler hematom ise kapsül boyunca koleksiyondur.

Kaynaklar

Bu sayfadaki 40 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 7 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.