İnsidental Olarak Saptanan Bochdalek Hernilerinin ÇKBT ile Değerlendirilmesi:

Giriş ve Amaç: Erişkinde çok kesitli bilgisayarlı tomografi ile insidental olarak saptanan asemptomatik Bochdalek Hernilerinin sıklığını araştırmak, obezite ve diyafragma krus kalınlığı ile BH arasındaki ilişkiyi değerlendirmektir.Gereç ve Yöntemler: 870 adet toraks ve abdomen çok kesitli bilgisayarlı tomografi tetkiki retrospektif olarak tarandı. Bochdalek Hernisi varlığı, prevalansı ve herni lokalizasyonu araştırıldı. Bochdalek Hernisi saptanan hastalarda aksiyal kesitlerde, defekt komşuluğundan diyafragma krus kalınlığı ve umblikus hizasında sağ paramedian alandan ciltaltı yağ dokusu kalınlığı ölçüldü. Ayrıca defektin boyutu ve herni kesesinin hacmi de aynı görüntülerde hesaplandı. Daha sonra defekt boyutları ve herni kesesinin hacmi ile diyafragma krus kalınlığı ve ciltaltı yağ dokusu kalınlığı arasında ilişki olup olmadığı araştırıldı.Bulgular: 30 hastada toplam 34 adet (%3,9) Bochdalek Hernisi saptandı. Bochdalek Hernisi 13 (%43.3) hastada sağda, 13 (% 43.3) hastada solda, 4 (%13.3) hastada ise bilateraldi. Herni kesesinin içeriği 32 (%94) hastada omental yağ dokusundan, 1 (%3) hastada karaciğerden, 1 (%3) hastada ise kolondan oluşmaktaydı. Herniye segment hacmi kadın hastalarda 153[84-361] µl, erkek hastalarda 339[202-432,5] µl hesaplanmış olup, bu değer kadın hastalarda istatistiksel açıdan anlamlı olacak şekilde daha düşüktü (p=0.032). Diyafragma krus kalınlığı ve ciltaltı yağlı doku ile hem herniye segment hacmi hem de defekt boyutu arasında anlamlı bir ilişki izlenmedi (p>0.05). Sonuç: Mevcut çalışmada çok kesitli bilgisayarlı tomografi ile saptanan, insidental Bochdalek Hernisi sıklığı % 3.9’dur ve herniye segment hacmi kadınlarda erkeklere oranla daha düşük bulunmuştur. Obezite diğer intraabdominal hernilerin patogenezinde önemli bir rol oynamasına rağmen, asemptomatik insidental Bochdalek Hernisi ile obezite ve diyafragma krus kalınlığı arasında anlamlı bir ilişki saptanmamıştır.

Anahtar Kelimeler:

Bochdalek Hernisi; Çok kesitli bilgisayarlı tomografi; Diyafragma

Evaluation of Incidental Bochdalek’s Herniae with MDCT:

Introduction: The objective of this study was to investigate the incidence of asymptomatic Bochdalek’s herniae detected incidentally with Multidetector Computed Tomography and to evaluate the correlation of Bochdalek herniae with obesity and the thickness of the diaphragmatic crus.Materials and Methods: A retrospective screening of the 870 multidetector computed tomography images of thorax and abdomen were performed. The prevalence and localization of Bochdalek herniae were investigated. In patients with Bochdalek herniae, the thickness of the diaphragmatic crus from the border of the defect and the thickness of the subcutaneous fat tissue in the right paramedian area at the level of umbilicus were measured in the axial sections. In addition, the size of the defect and the hernia sac volume were calculated in the same images. Then, the presence of a correlation between defect sizes and hernia sac volumes and the thickness of the diaphragmatic crus and subcutaneous fat tissue were evaluated.Results: 34 BH (3.9%) were detected in 30 patients. Bochdalek herniae was on the left side in 13 patients (43.3%), on the right side in 13 patients (43.3%) and was bilateral in 4 patients (13.3%). The content of the hernia sac consisted of omental fat tissue in 32 patients (94%), of liver in 1 patient (3%) and of colon in 1 patient (3%). The segmental volume of hernia was lower in female patients [153µ;84µ -361µ] thanin male patients [339µ; 202µ -432.5µ] and the difference was statistically significant (p=0.032). There was no significant correlation between the thickness of the diaphragmatic crus and the subdermal fat tissue and both segmental volume and defect size of hernia (p>0.05). Conclusions: In the present study, the incidence of the incidental Bochdalek herniae detected with Multidetector Computed Tomography is 3.9% and the segmental volume of hernia is significantly lower in females compared with males. Although obesity plays an important role in the pathogenesis of intraabdominal hernia, no significant correlation between the asymptomatic incidental Bochdalek herniae and obesity and thickness of the diaphragmatic crus was detected.

Keywords:

Bochdalek Hernia; Multidetector Computed Tomography; diaphragma,

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