The Current Role of Abdominal Ultrasound in the Clinical Management of Patients with AIDS

 

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Zusammenfassung

Patienten mit Aids zeigen aufgrund der Beteiligung zahlreicher Organe eine große Bandbreite klinischer Erscheinungen. Ultraschall (US) kann einfach und auch wiederholt durchgeführt werden, ist sicher, kostengünstig und nichtinvasiv. Diese Eigenschaften sind für Aids-Patienten entscheidend, da sie in industrialisierten Ländern dank der Einführung der „hochaktiven antiretroviralen Therapie” meist ambulant betreut werden. Mit US können die meisten von Aids betroffenen Organe untersucht werden. Ebenso können US-geführte Biopsien durchgeführt werden, die zytohistologische und mikrobiologische Untersuchungen als Voraussetzungen für eine eindeutige Diagnosestellung ermöglichen. Diese Arbeit verschafft eine Übersicht über die große Bandbreite der klinischen Anwendung des Abdominal-Ultraschalls und verdeutlicht den Stellenwert dieser Methode für die Bewältigung dieser komplexen und sich verändernden Erkrankung insbesondere in solchen Verhältnissen, in denen kostspieligere Untersuchungsmethoden nicht - und auch in absehbarer Zeit noch nicht - zur Verfügung stehen. Die zunehmende Anwendung portabler Ultraschallgeräte verstärkt noch den Nutzen dieser Technik unter solchen Umständen. Mit neuen Behandlungsmethoden verändern sich Prävalenz und Morbiditäts-/Mortalitätsraten, aber es entstehen auch neue Manifestationen und Nebenwirkungen. Die Ultraschall-Anwendung bei diesen neuen Erscheinungen wird ebenfalls diskutiert.

Abstract

Patients with AIDS present a wide variety of clinical manifestations through involvement of various organs. Ultrasonography (US) is easy to perform, safe, inexpensive, not invasive and repeatable. Those features are crucial for AIDS patients, who in industrialised countries are now mostly seen on an outpatient basis thanks to the introduction of Highly Active Antiretroviral Therapy. US can investigate most of the organs affected in AIDS and can guide biopsies, allowing the cyto-histological and microbiological investigations needed for a definitive diagnosis. This paper reviews the wide variety of applications of abdominal US and stresses its importance in the management of a complex and changing condition, particularly in settings where other more expensive imaging techniques are not - and will not be for a long time - available. The increasing use of portable - hand-carried scanners further adds to the value of the technique in such settings. With new treatments, prevalence and morbidity/mortality rates change, but new conditions and new side effects appear. US applications to these new conditions are discussed as well.

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Enrico  Brunetti, MD

Division of Infectious and Tropical Diseases, IRCCS S. Matteo-University of Pavia

Via Taramelli 5

27100 Pavia

Italy

Phone: ++ 39/03 82/50 27 99-6 60

Fax: ++ 39/03 82/30 19 87

Email: selim@unipv.it