Transthorakale Sonografie bei der Diagnostik pulmonaler Erkrankungen: ein systematischer Zugang

 

 Buy Article Permissions and Reprints

Kernaussagen

• Durch den Einsatz portabler Geräte kann die TS nach Anamnese und körperlicher Untersuchung als erstes bildgebendes Verfahren sofort und überall eingesetzt werden.

• Mittels TS ist es möglich, eine Vielzahl von pneumologischen Erkrankungen zu diagnostizieren bzw. frühzeitig das weitere diagnostische und therapeutische Procedere ökonomisch festzulegen.

• Rein zentral lokalisierte Prozesse entgehen der TS.

• Mittels TS können alle sonografisch darstellbaren Prozesse auch sonografisch gesteuert bioptiert und im Verlauf kontrolliert werden.

• Die Beurteilung der Vaskularisation erfolgt mittels FDS, Spektralkurvenanalyse und KUS. Die KUS ist grundsätzlich nicht geeignet, benigne von malignen peripheren Läsionen zu differenzieren. Weitere Studien sind erforderlich, um den Stellenwert der Vaskularisationsanalyse zu definieren.

Main statements

• Through the use of portable devices, transthoracic ultrasound of lung and pleura can be used after anamnesis and physical examination immediately and everywhere as the first imaging method.

• Using transthoracic ultrasound of lung and pleura, it is possible to diagnose a number of pneumological diseases or to economically define diagnostic and therapeutic procedures early.

• Centrally located processes are not detected by transthoracic ultrasound of lung and pleura.

• Using transthoracic ultrasound of lung and pleura, all sonographically visualizable processes can be biopsied in a sonographically controlled manner and their progress can be monitored.

• Vascularization is evaluated via color Doppler sonography, spectral curve analysis, and contrast agent-enhanced ultrasound. As a rule, contrast agent-enhanced ultrasound is not suitable for differentiating benign from malignant peripheral lesions. Additional studies are necessary to define the importance of vascularization analysis.

Literatur/References

• 1 Beckh S, Bölcskei P L, Lessnau K D. Real-time chest ultrasonography: a comprehensive review for the pulmonologist.  Chest. 2002;  122 1759-1773
  Google Scholar
• 2 Reißig A, Heyne J P, Kroegel C. Sonography of lung and pleura in pulmonary embolism: sonomorphologic characterization and comparison with spiral CT scanning.  Chest. 2001;  120 1977-1983
  Google Scholar
• 3 Mathis G, Blank W, Reißig A. et al . Thoracic ultrasound for diagnosing pulmonary embolism. A prospective multicenter study of 352 patients.  Chest. 2005;  128 1531-1538
  Google Scholar
• 4 Mathis G. Thoraxsonographie – Teil 1: Brustkorb und Pleura.  Praxis. 2004;  93 615-621
  Google Scholar
• 5 Mathis G. Thoraxsonographie – Teil 2: Subpleurale Läsionen.  Praxis. 2004;  93 791-724
  Google Scholar
• 6 Reißig A, Kroegel C. Sonographic Diagnosis and Follow-Up of Pneumonia: A Prospective Study.  Respiration. 2007;  74 537-547
  Google Scholar
• 7 Copetti R, Cattarossi L. Ultrasound diagnosis of pneumonia in children.  Radiol med. 2008;  113 190-198
  Google Scholar
• 8 Reißig A, Kroegel C. Accuracy of transthoracic sonography in excluding post-interventional pneumothorax and hydropneumothorax. Comparison to chest radiography.  Eur J Radiol. 2005;  53 463-470
  Google Scholar
• 9 Chung M J, Goo J M, Im J G. et al . Value of high-resolution ultrasound in detecting a pneumothorax.  Eur Radiol. 2005;  15 930-935
  Google Scholar
• 10 Sartori S, Tombesi P, Trevisani L. et al . Accuracy of transthoracic sonography in detection of pneumothorax after sonographically guided lung biopsy: Prospective comparison with chest radiography.  AJR. 2007;  188 37-41
  Google Scholar
• 11 Zhang M, Liu Z H, Yang J X. et al . Rapid detection of pneumothorax by ultrasonography in patients with multiple trauma.  Critical Care. 2006;  10 R112
  Google Scholar
• 12 Reißig A, Kroegel C. Transthoracic sonography of diffuse parenchymal lung disease. The role of comet tail artifacts.  J Ultrasound Med. 2003;  22 173-180
  Google Scholar
• 13 Görg C, Bert T. Transcutaneous color Doppler sonography of lung consolidations. Review and pictorial essay. Part 1: Pathophysiologic and colour Doppler sonographic basics of pulmonary vascularity.  Ultraschall in Med. 2004;  25 221-226
  Google Scholar
• 14 Görg C, Bert T. Transcutaneous color Doppler sonography of lung consolidations. Review and pictorial essay. Part 2: Colour Doppler sonographic patterns of pulmonary consolidations.  Ultraschall in Med. 2004;  25 285-291
  Google Scholar
• 15 Görg C, Bert T. Transcutaneous contrast enhanced sonography of the chest for evaluation of pleural based pulmonary lesions: experience in 137 patients.  Ultraschall in Med. 2006;  27 437-444
  Google Scholar
• 16 Görg C. Transcutaneous contrast-enhanced sonography of pleural-based pulmonary lesions.  EJR. 2007;  64 213-221
  Google Scholar
• 17 Beckh S, Blank W, Kubale R. et al . den Arbeitskreis Thoraxsonographie der DEGUM. Untersuchungsstandard für die transthorakale Sonographie.  Ultraschall in Med. 2006;  27 287-288
  Google Scholar
• 18 Wipf J E, Lipsky B A, Hirschmann J V. et al . Diagnosing pneumonia by physical examination. Relevant or relic?.  Arch Intern Med. 1999;  159 1082-1087
  Google Scholar
• 19 Bandi V, Lunn W, Ernst A. et al . Ultrasound v. CT in detecting chest wall invasion by tumor. A prospective study.  Chest. 2008;  133 881-886
  Google Scholar
• 20 Prosch H, Mathis G, Mostbeck G H. Perkutaner Ultraschall in Diagnose und Staging des Bronchialkarzinoms.  Ultraschall in Med. 2008;  29 466-484
  Google Scholar
• 21 Görg C, Bert T, Görg K. Contrast-Enhanced sonography for differential diagnosis of pleurisy and focal pleural lesions of unknown cause.  Chest. 2005;  128 3894-3899
  Google Scholar
• 22 Niemann E, Egelhof T, Bongratz G. Transthoracic sonography for the detection of pulmonary embolism – a meta-analysis.  Ultraschall in Med. 2009;  30 150-156
  Google Scholar
• 23 Wüstner A, Gehmacher O, Hämmerle S. et al . Ultrasound diagnosis in blunt thoracic trauma.  Ultraschall in Med. 2005;  26 285-290
  Google Scholar
• 24 Reißig A, Kroegel C. Diagnosis of pulmonary embolism and pneumonia using transthoracic sonography. Bollinger CT, Herth FJF, Mayo PH, Miyazawa T, Beamis JF Clinical Chest Ultrasound: From the IUC to the Bronchoscopy Suite. Prog Respir Res Basel; Karger 2009 37: 43-50
  Google Scholar

Priv.-Doz. Dr. med. Angelika Reißig

Pneumologie & Allergologie, Klinik für Innere Medizin I, Friedrich-Schiller-Universität

Erlanger Allee 101

07740 Jena

Phone: + + 49/36 41/9 32 41 28

Fax: + + 49/36 41/9 32 41 32

Email: angelika.reissig@med.uni-jena.de