Travmatik psödoanevrizma BT bulguları

Özet

Kısmi arter duvarı yırtığı, kanın çevre dokularla sınırlanmış bir kese içinde birikmesine neden olabilir. BTA'da ana arterle boyun üzerinden devam eden ve kan havuzuyla benzer kontrastlanan kese, yaralanmanın yerini ve damar ilişkisini ortaya koyar. BTA, damar yaralanmalarını göstermeye ve kanama kaynağını lokalize etmeye yardımcı olur.

Okuma sırası

Şüpheli sakküler kontrast odağı. Travma hematomu içindeki kontrastlı yuvarlak odağa yönelin; odağın damarın dış konturuna göre nerede yer aldığını belirleyin.
Kese boynu ve ana arter. Arter kesitlerini ince aralıklarla ve ortogonal MPR'da takip edip kese lümeninin ana damara bağlandığı boynu bulun.
Gecikmiş faz kese konturu. Gecikmiş faz varsa aynı keseyi yeniden açın; sınırın sınırlı kalmasını ve hematom içine yeni kontrast yayılımı olmamasını kontrol edin.
Perivasküler hematom ve distal arter. Kesenin çevresindeki hematomu ve arterin distalindeki kontrast dolumunu göstererek eşlik eden kanama veya akım kısıtlılığını tarif edin.

Faz ve pencere

BTA tanısal: Arter lümeninden dışarı doğru uzanan, ana damar kan havuzuyla benzer atenüasyonda yuvarlak veya oval kontrast kesesi ve mümkünse kese boynu görülür; çevresel hematom eşlik edebilir.
Gecikmiş tanısal: Kese sınırlı, aynı yerde ve benzer biçimde kalır; ekstravazasyon gibi hematom boyunca şekil değiştirip yayılmaz. Damarla bağlantı ve gecikmiş dolum kesenin değerlendirilmesini güçlendirir.

Önerilen pencereler: Anjiyo (G 600 / M 150), Yumuşak doku (G 400 / M 40).

BT bulguları

Sakküler kontrast çıkıntısı — arter dış konturundan kese biçiminde taşar ve lümenle boyun üzerinden bağlantı gösterir.
Ebeveyn arterle eş kontrastlanma — kese içi atenüasyon arteriyel fazda komşu arter kan havuzuna yakındır.
Sabit gecikmiş morfoloji — sonraki fazda kese serbestçe büyüyüp çevre hematoma yayılmaz.
Duvar kusuru — kese boynunun çıktığı noktada arter konturu kesintili ya da düzensiz görünebilir.
Perivasküler kanama — kesenin çevresindeki hematom, eşlik eden damar duvarı ve yumuşak doku hasarını gösterir.
Distal lümen etkisi — kese boynuna yakın daralma, mural trombüs veya distal akım azalması aynı yaralanmaya eşlik edebilir.
Komşu travma yolu — penetran yarada yara kanalı, kemik fragmanı veya yabancı cisim kese oluşumunun olduğu arter segmentine yaklaşabilir.

Normalde

Normal arterin dış konturu düzgün ve lümeni kesintisizdir; damar boyunca kontrastla dolan kese biçimli çıkıntı bulunmaz. Şüpheli odakta arterden çıkan iyi sınırlı kese biçimli lezyonu ve gecikmiş görüntülerde büyüyüp büyümediğini değerlendirin.

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 s0115; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Aktif kontrast ekstravazasyonu, damar lümeni dışında düzensiz kontrastlanma olarak görülür ve sonraki fazlarda boyut ya da atenüasyonu artabilir.
Arter diseksiyonu: damar duvarı boyunca uzanan intimal flep ya da çift lümen oluşturur; sakküler kontrast kesesi temel bulgu değildir.
Travmatik arteriyovenöz fistül: yaralanma yakınındaki ven arteriyel fazda beklenenden erken opaklaşır.
Psödoanevrizma taklit eden kıvrımlı arter dalı: MPR'da devamlı arteriyel seyir gösterir ve ayrı kese boynu yoktur.
Yabancı cisim veya mermi parçaları: demir sertleşmesi artefaktı yaratarak damar kontürünü bozabilir ve psödoanevrizma değerlendirmesini zorlaştırabilir.

Tuzaklar

Tek fazda sınırlı ekstravazasyon psödoanevrizmayı taklit edebilir; gecikmiş fazda kese sınırının sabit kalıp kalmadığını kontrol edin.
Küçük kese ana damar düzlemine paralel kesitte gözden kaçabilir; aksiyel görüntüye ek olarak koronal ve sagittal MPR'da boyun bağlantısını izleyin.
Kese içindeki kısmi trombüs kontrastla dolan lümeni olduğundan küçük gösterebilir; dış kese konturunu yumuşak doku penceresinde de inceleyin.

Kendini dene

Penetran ekstremite travmasında arterden boyunla ayrılan düzgün kontrast kesesi gecikmiş görüntüde aynı boyutta kalıyor. Tanı nedir?
Cevabı göster
Travmatik psödoanevrizma. Arterle bağlantılı ve gecikmiş fazda sınırlı kalan kontrast kesesi psödoanevrizmayı destekler. Ekstravazasyon yayılır, fistülde erken venöz dolum aranır, diseksiyon lümen içi flep veya çift lümen yapar.
BTA'da travma odağına komşu ven arteriyel fazda aynı taraftaki arterle eş zamanlı opaklaşıyor. Hangi yaralanma düşünülür?
Cevabı göster
Arteriyovenöz fistül. Yaralanma komşuluğundaki venin erken arteriyel opaklaşması arter ile ven arasında şantı düşündürür. Psödoanevrizma kese oluşturur; tromboz akımı azaltır; kalsifikasyon faz zamanlamasını değiştirmez.

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Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 4 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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