Künt boyun travması olan vakalarda boyun arteriyel sisteminin postmortem anjiografi yöntemi ile değerlendirilmesi

Yıl 2020, Cilt: 34 Sayı: 2, 79 - 94, 15.08.2020

Ufuk Aksoy Özlem Aksoy Murat Nihat Arslan Bülent Şam

https://izlik.org/JA74HE28FR

Öz

AMAÇ: Boyun, baş ile gövde arasında, başı desteklemedeki rolüne ek olarak kafa ve vücut arasında bulunan damar ve sinirler için bir kanal, sindirim ve solunum sistemi için de bir geçiş yolu olan vücut bölgesidir. Bu çalışmada hayati açıdan önemli yapılar içeren boyun bölgesinde çok farklı mekanizmalarla meydana gelebilecek yaralanmalarda, invaziv otopsi girişimlerinden önce boyun arteryel sisteminin anjiografik yöntem ile incelenmesinin hem tanıda hem de triajda sağlayacağı yararlar araştırılmıştır. YÖNTEM: Çalışma kapsamında İstanbul Morg İhtisas Dairesinde künt boyun travması olan vakalarda ve travması olmayan seçilmiş kontrol vakalarında henüz kafa ve boyun bölgesi açılmadan göğüs açılarak arcus aorta bölgesinde truncus brachiocephalicus’a, subklavian arterin ilk bölümüne ve karotis arterlere ulaşılarak bu bölgeden radyokontrast madde verilmiş ve arteriyel sistem radyolojik olarak görüntülenmiştir. Bu şekilde tespit edilen anatomik yapı görüntüleri kayda alınmış, değerlendirilmiş ve görüntülemenin etkinliği tartışılmıştır. BULGULAR: Bu çalışmada 9’u travmatik bulgulara sahip 24 vakada boyun bölgesinde bulunan ve yaralanması hayati risk doğuran en önemli yapılardan biri olan büyük arteriyel yapıların anjiografik incelemelerinde künt boyun travması olduğu düşünülen vakalarda diseksiyon ve arteriovenöz fistül gibi direkt ölüm ile ilişkili olabilecek yaralanmalar tespit edilmekle birlikte posttravmatik trombozlar gibi ölüme katkısı olabilecek ancak adli otopsilerde zorlukla ulaşılabilecek bölgelerde bulunan arteriyel yapılara ait önemli bulgular da elde edilmiştir. Ayrıca büyük arterlerin travmatik ve bazı cerrahi operasyonlarda iyatrojenik olarak yaralanmasına neden olabilecek damar varyasyonları 6 vakada açık şekilde izlenmiştir. SONUÇ: Boyun arteriyel sisteminin postmortem anjiografik yöntemler ile incelenmesinin otopsi süresini uzatmayan, henüz daha cilt altı katmanlar açılmadan ve dolayısıyla artefakt oluşturmadan boyun arteriyel sisteminin değerlendirilmesini sağlayan bir yöntem olduğu görülmüş, özellikle endikasyonu doğru konularak rutin bir şekilde uygulanması ile hem tanı koydurucu hem de otopsi tekniğini yönlendirici bir teknik olarak ön plana çıkmıştır.

Anahtar Kelimeler

Otopsi , boyun arteriyel sistemi , postmortem anjiografi

Evaluation of neck arterial system via postmortem angiography techniques on cases with blunt neck trauma

https://izlik.org/JA74HE28FR

Öz

INTRODUCTION: The neck is the part of the body that connects the head and the torso, a conduit for the vessels and nerves between the head and the rest of the body, in addition to its role in supporting the head and serving as the passageway for the digestive and respiratory systems. This study investigated the benefits of neck arterial system angiography techniques in both diagnosis and triage before invasive autopsy techniques following injuries that may affect the many mechanisms in the neck region, which contains vitally important structures. METHODS: Within the scope of the study, in cases with blunt neck trauma and selected control cases without trauma in the Istanbul Morgue Department, the chest was opened without opening the head and neck region. The truncus brachiocephalicus in the arcus aorta region, the first part of the subclavian artery, and the carotid arteries were reached. Radiocontrast was applied from this region and the arterial system evaluated. Anatomical structure images were recorded and evaluated, and the effectiveness of imaging was discussed. RESULTS: The causes of death were given using 906 different phrases in 16,523 reports. When general classification was performed, these could be grouped under 131 headings. When the causes of death given in the Morgue Department were classified via both the proposed coding system and the ICD-10 codes, the lists of the leading 20 causes of death were similar in descriptive statistical data. CONCLUSION: It was observed that examination of the neck arterial system with postmortem angiographic methods allows the evaluation of the neck arterial system without opening subcutaneous layers and thus without creating artefacts and does not prolong the autopsy period, especially with the correct indication and its routine application. This has come to the fore as both a diagnostic technique and a technique that guides the autopsy procedure.

Anahtar Kelimeler

Autopsy , neck arterial system , postmortem angiography

Kaynakça

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