F. Sema OYMAK, İbrahim KARAHAN, Şükrü ÜNAL, Ramazan DEMİR, Mustafa ÖZESMİ, Levent KART

Pulmoner arter trombozlarında klinik ve radyolojik tanı

Dünyada her yıl 500.000'den fazla hasta en az bir veya daha fazla pulmoner emboli (PE) atağı geçirmektedir. Bu makalede pulmoner tromboemboli düşünülüp yatırılan ve yapılan bilgisayarlı tomografi ve MR incelemelerinde majör pulmoner arterlerde tromboz tesbit edilen beş vaka incelenmiştir. Birinci vakanın toraks BT'sinde sağ ana pulmoner arterde trombus, sağ posterobazal segmentte plevral tabanlı üçgen şeklinde konsolide alan gözlendi. İkinci vakanın toraks BT'sinde her iki pulmoner arter içerisinde trombüs ile uyumlu görünüm izlendi. Üçüncü vakanın çekilen toraks BT'sinde sağ ana pulmoner arterde trombüsle uyumlu hipodens alan görülmekteydi. Dördüncü vakanın toraks BT'sinde sağ ana pulmoner arterden uç dallara doğru uzanan hipodens trombüs saptandı. Beşinci vakanın Toraks BT'sinde ise pulmoner arterlerde patoloji yoktu. MR anjiografide sağ pulmoner arterde santral lokalizasyonlu trombüsle uyumlu görünüm mevcuttu. Sonuç olarak, pulmoner emboli odağı olarak alt ekstremite ve pelvik venlerde herhangi bir odak bulunmayan vakalarda ana pulmoner arterlerde ve kalpte dinamik CT ve MR angiografi ile trombus aranmalıdır.

Clinical and radiological diagnosis of pulmonary artery thromboses

More than 500 000 people in the world experienced one or more pulmonary emboli attack every year. In this article, we presented five cases who were hospitalized for pulmonary thromboembolism and found to have thrombus in major pulmonary arteries by using computed tomography (CT) or MRI. The first case was a 56 year-old male patient in thoracal CT showed the presence of a thrombus in the right main pulmonary artery and a pleural based, triangle shaped consolidation in the posterobasal segment of the right lung. The second case was a 72 year-old women in thoracal CT examination revealed the presence of thrombus in both of pulmonary arteries. The third case was a 46 year-old women in thoracal CT of the patient showed a hypodense lesion in the right pulmonary artery suggesting thrombus. The fourth case was a 37 year-old man in thoracal CT in this patient also showed a hypodense thrombus in the right pulmonary artery. The fifth case was a 45 year-old man, while thoracal CT revealed no pathology in pulmonary arteries of the patient, MR angiography showed the presence of a centrally located thrombus in the right pulmonary artery. As a result, our findings suggested that in patients with pulmonary thromboembolism who has no focus in lower extremities or pelvic veins, any thrombus located in pulmonary arteries or in heart should be investigated by dynamic CT or MR angiography.

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