Bronchiolitis

 

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Zusammenfassung

Die Variabilität der Bronchiolitiden im Hinblick auf Ätiologie, Histopathologie, Lungenfunktion, Bildgebung und klinische Präsentation ebenso wie die Überlagerung mit anderen pulmonalen Veränderungen lassen oft nicht unmittelbar eine bronchioläre Erkrankung erkennen. Deshalb sollte die Möglichkeit einer Erkrankung der kleinen Atemwege immer in die differenzialdiagnostischen Überlegungen mit einbezogen werden. Der diagnostische Zugang lässt sich in mehrere Schritte unterteilen: die Schritte 1 (Anamnese und körperliche Untersuchung) und 2 (Röntgen-Thorax und Lungenfunktion) machen auf die Möglichkeit des Vorliegens einer Bronchiolitis aufmerksam. Das HRCT (mit Exspirationsschnitten) im Schritt 3 weist anhand der typischen Muster (Blütenzweig- bzw. Tree-in-Bud-Zeichen, unscharf begrenzte zentrilobulär lokalisierte, flaue Noduli und/oder Mosaik-Muster [deutlicher erkennbar im exspiratorischen CT]) eine bronchiolitische Beteiligung nach und grenzt zugleich die infrage kommende Form der Bronchiolitis ein. Die Diagnose einer Bronchiolitis beruht auf der integrierten Bewertung aller erhobenen Befunde. Eine histologische Diagnostik kann im Zweifelsfall die Diagnostik ergänzen. Die Übersicht erläutert den diagnostischen Zugang beim Verdacht auf Bronchiolitis anhand eines einfachen, klinisch praktikablen Algorithmus.

Abstract

Due to the variability in respect to aetiology, histopathology, lung function, imaging and clinical presentation, as well as overlapping parenchymal processes, bronchiolar disorders are generally difficult to diagnose. Thus, diseases of the small airways should generally be considered in the differential diagnostic approach to respiratory conditions. The diagnostic approach can be devided into several steps: in steps 1 (history and physical examination) and 2 (plain chest radiographs and pulmonary function tests) may point towards a bronchiolar pulmonary process. High-resolution CT (HR-CT) scanning of the chest provides three distinct HR-CT patterns (tree-in-bud sign, ill-defined centrilobular ground-glass nodules and/or pattern of mosaic attenuation, especially visible on expiratory images) which confirm a bronchiolic involvement and help to narrow down a likely diagnosis or more specific bronchiolitic diseases. In inconclusive cases, a histological diagnosis may be required. The paper presents a clinically useful algorithmic approach to diagnosis and differential diagnosis of bronchiolar disorders.

^* für die DESA
DESA (Deutsche Expertengruppe Small Airways) sind Dr. Peter Haidl, Prof. Dr. Martin Kohlhäufl, Dr. Dr. Joachim Körner, Prof. Dr. Dr. Claus Kroegel, Manuela Kulle, Dr. Detlef Nachtigall, Dr. Astrid Riebeling, Prof. Dr. Andreas Schmitt, Prof. Dr. Thomas Voshaar

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