Adrenal travma ve hematom

Özet

Künt gövde travmasında adrenal yaralanma seyrek görülür ve çoğu kez yüksek enerjili travmanın başka bulguları arasında fark edilir. BT’de adrenal bez genişlemesi, yüksek veya karışık atenüasyonlu kanama odağı, çevre yumuşak doku çizgilenmesi ve retroperitoneal hematom yaralanmayı düşündürür; kontrastsız BT’de akut kanama yüksek atenüasyonlu, kontrastlanmayan bir lezyon olarak görülebilir. Tek taraflı travmatik adrenal kanama genellikle çoklu organ yaralanmalarıyla birlikte görülür; bilateral adrenal kanama adrenal yetmezliğe yol açabilir. Bilateral adrenal kanama fark edilmezse primer adrenal yetmezliğe ve potansiyel olarak ölümcül adrenal krize yol açabilir.

Faz ve pencere

Kontrastsız tanısal

Akut kanama bez içinde oval ya da bezin üçgensi biçimini koruyan genişlemiş yüksek atenüasyonlu alan olarak görülür; akut hematom yaklaşık 50–90 HU olabilir. Kontrastlı faz yoksa da hematom yoğunluğu ve çevre yağ planları seçilebilir.

Portal tanısal

Adrenal parankim içindeki hematom kontrastlanmaz; erken dönemde periferik bez dokusu kontrastlanırken merkezde düşük atenüasyonlu kanama tram-track görünümü verebilir. Periadrenal yağ çizgilenmesi ve retroperitoneal hematom eşlik edebilir.

Arteriyel tanısal

Aktif kanama şüphesinde adrenal bölge çevresinde veya hematom içinde kontrast ekstravazasyonu aranır.

Önerilen pencereler: Batın (G 400 / M 50), Yumuşak doku (G 400 / M 40).

BT bulguları

• Bez genişlemesi — normal ince Y veya ters V biçimli adrenal kol kalınlaşır, oval ya da yuvarlak görünüm alır.
• Yüksek atenüasyonlu intraglandüler kan — kontrastsız seride bez dokusundan belirgin yoğun, düzgün ya da heterojen içerik.
• Tram-track görünümü — çevresel kontrastlanan adrenal doku, merkezdeki hipodens kanama alanını sınırlar.
• Periadrenal yağ çizgilenmesi — bez çevresi yağda silinme ve ince yumuşak doku dansitesi artışı.
• Retroperitoneal hematom — kanama adrenal lojdan perirenal veya üst retroperitoneal aralığa uzanabilir.
• Aktif kontrast ekstravazasyonu, kontrastlı BT’de bez çevresinde veya hematom içinde görülebilir.
• Travmatik adrenal kanama genellikle tek taraflıdır; olguların yaklaşık %5’inde bilateral tutulum görülebilir.

Ölçütler ve sınıflamalar

Akut adrenal hematom atenüasyonu

50–90 HU

Normalde

Normal adrenal bezler BT’de normal görünümlü olarak izlenir. Karşı bezin aynı düzeydeki kol kalınlığını ve çevre yağ dokusunun temizliğini kıyaslayın; travma lehine olan değişiklik bezin yeni yuvarlaklaşması, iç atenüasyon artışı veya periadrenal çizgilenmedir.

Ayırıcı tanı

Adrenal adenom

kanama benign tümörlerde malign neoplazmlara göre daha nadirdir; ancak altta yatan bir adenomun varlığı da hematom oluşumunu açıklayabilir.

Adrenal metastaz

akciğer kanseri gibi primer tümörlerden metastaz kanamayla seyredebilir; hastanın onkolojik öyküsü ve başka metastatik odaklar değerlendirilmelidir.

Miyelolipom

makroskopik yağ içeren odak, hematomdan negatif atenüasyonlu yağ bileşeniyle ayrılır.

Adrenal kitle içine kanama

hematom zamanla küçülmeyebilir; takipte kalıcı solid kontrastlanan bileşen altta yatan lezyonu düşündürür.

Periadrenal retroperitoneal kanama

kan adrenal bezin içinde değil, bez çevresindeki fasya planlarında yer alır; bez konturu ayrı seçilebilir.

Tuzaklar

• Portal fazdaki kontrastlanmış bez ve damarlar yalancı yüksek atenüasyon oluşturabilir; kanın gerçek yoğunluğunu kontrastsız seriyle eşleştirin.
• Periadrenal yumuşak doku çizgilenmesi adrenal kanama için önemli bir ipucu olabilir; bilateral tutulum olasılığı nedeniyle her iki adrenal bezi de değerlendirin.
• Travma hastasındaki adrenal kitleyi otomatik olarak hematom kabul etmeyin; önceki görüntülemeyle karşılaştırma ve izlemde kitlenin küçülmesi, altta yatan bir lezyonu değerlendirmeye yardımcı olur.

Kendini dene

1. Künt travma sonrası kontrastsız BT’de adrenal bezde yüksek atenüasyonlu, kontrastlanmayan oval bir lezyon ve çevresinde yumuşak doku çizgilenmesi görülüyor. En olası tanı nedir?

   • Adrenal hematom
   • Adrenal adenom
   • Miyelolipom
   • Adrenal metastaz
   Cevabı göster

   Adrenal hematom. Travma sonrasında adrenal bezde gelişen yüksek veya karışık atenüasyonlu, kontrastlanmayan lezyon kanamayla uyumludur; çevre yumuşak doku çizgilenmesi de tanıyı destekler.

2. Adrenal bez içindeki odakta makroskopik yağ dansitesi görülüyor. En olası adrenal lezyon hangisidir?

   • Miyelolipom
   • Akut adrenal hematom
   • Adrenal adenom
   • Adrenal metastaz
   Cevabı göster

   Miyelolipom. Miyelolipom makroskopik yağ içerir ve bu özellik onu akut kanamadan ayırır. Akut hematom kan ürünleriyle yüksek atenüasyon gösterir; adenom ve metastaz solid adrenal lezyonlardır.

Kaynaklar

Bu sayfadaki 39 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 11 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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