Toraksın Girişimsel İşlemleri
Özet
Toraksta uygulanan nonvasküler ve vasküler girişimsel radyolojik işlemler, teşhis ve tedavi süreçlerinde kritik bir rol oynamaktadır. Doku örneklemesinde standart kılavuz yöntem olan perkütan torasik biyopsinin (PTAB) endikasyonları, kanama bozuklukları gibi kesin kontrendikasyonları ve en sık görülen pnömotoraks ile pulmoner hemoraji gibi komplikasyonları detaylandırılmaktadır. Plevral girişimlerde, US veya BT eşliğinde gerçekleştirilen torasentez ile kateter drenaj işlemlerinde Seldinger ve trokar teknikleri karşılaştırılmakta, hızlı sıvı boşaltımlarında gelişebilecek fatal reekspansiyon pulmoner ödemine dikkat çekilmektedir. Akciğer tümör ablasyonu bölümünde, cerrahiye uygun olmayan hastalarda radyofrekans, mikrodalga, kriyoblasyon ve elektroporasyon yöntemlerinin kullanımı, hasta seçimi kriterleri ve işlem sonrası BT/PET ile takip protokolleri incelenmektedir. Vasküler işlemler kapsamında, masif hemoptizide acil bir tedavi olan bronşiyal arter embolizasyonu (BAE) ve işlem öncesi BT anjiyografinin tanısal değeri vurgulanırken, spinal iskemi gibi riskler belirtilmektedir. Son olarak, hayatı tehdit eden masif pulmoner embolide kateter trombektomi yöntemleri ile pulmoner arteriovenöz malformasyonların (PAVM) standart tedavisi olan embolizasyon işlemleri ele alınmaktadır.
Nonvascular and vascular interventional radiological procedures performed in the thorax play a critical role in both diagnostic and therapeutic management. The indications, absolute contraindications such as bleeding disorders, and common complications like pneumothorax and pulmonary hemorrhage associated with percutaneous thoracic biopsy (PTAB)—the standard guided method for tissue sampling—are detailed. Regarding pleural interventions, thoracentesis and catheter drainage procedures performed under US or CT guidance using Seldinger and trocar techniques are compared, highlighting the risk of fatal re-expansion pulmonary edema during rapid fluid evacuation. In the lung tumor ablation section, the utilization of radiofrequency, microwave, cryoablation, and electroporation methods for medically inoperable patients, along with patient selection criteria and post-procedure follow-up protocols via CT/PET, is examined. Within vascular interventions, bronchial artery embolization (BAE) is emphasized as an emergency treatment for massive hemoptysis, noting the diagnostic value of pre-procedural CT angiography and severe risks like spinal ischemia. Finally, catheter thrombectomy methods for life-threatening massive pulmonary embolism and embolization procedures, which serve as the standard treatment for pulmonary arteriovenous malformations (PAVM), are reviewed.
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