Zusammenfassung
Lungenmetastasen stellen sich bildgebend typischerweise als meist multiple und bilaterale, scharf begrenzte weichteildichte Lungenrundherde mit basal und peripher betonter Lokalisation dar. Unscharfe Begrenzung, Einschmelzungen, Verkalkungen oder endobronchiale Lage sind selten. Aufgrund fehlender pathognomonischer Befunde ist eine eindeutige differenzialdiagnostische Abgrenzung von anderen—auch benignen—Lungenrundherden jedoch kaum möglich. Der computertomographische oder magnetresonanztomographische Nachweis einer Kontrastmittelaufnahme oder von Wachstum in Verlaufsuntersuchungen unterstützt die Diagnose. In Zweifelsfällen führt die perkutane Biopsie als Feinnadelaspiration oder Stanzbiopsie bei vertretbarer Belastung des Patienten meist zur Diagnose. Die einzige relativ häufige Nebenwirkung—der postpunktionelle Pneumothorax—kann und sollte vom interventionellen Radiologen durch Aspiration oder Katheterdrainage selbst therapiert werden.
Abstract
Pulmonary metastases typically present as mostly multiple and bilateral, well-defined, non-calcified pulmonary nodules with predominantly basal and peripheral location. Ill-defined, cavitating, calcified and endobronchial metastases are uncommon.
In the absence of pathognomonic findings precise differentiation from other—even benign—pulmonary nodules is almost impossible. Demonstration of contrast enhancement at CT or MRI or evidence of growth at serial examinations support the diagnosis of pulmonary metastases.
In uncertain cases percutaneous fine-needle aspiration or cutting needle biopsy will allow diagnosis with acceptable risk of complications and patient discomfort. The only relatively common complication of pneumothorax can and should be controlled by the interventional radiologist by aspiration or drainage.
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Diederich, S. Bildgebende Diagnose und Differenzialdiagnose von Lungenmetastasen. Radiologe 44, 663–670 (2004). https://doi.org/10.1007/s00117-004-1068-y
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DOI: https://doi.org/10.1007/s00117-004-1068-y