Zusammenfassung
Bei der chronischen Lungenembolie sind Abschnitte der arteriellen Lungenstrombahn dauerhaft verschlossen. Dies kann zu einer Erhöhung des pulmonal-arteriellen Drucks mit den Folgen einer Rechtsherzbelastung und strukturellen Veränderungen der Pulmonalarterien führen. Bildmorphologisch nachzuweisen sind Gefäßverschlüsse (Pulmonalisangiographie, MSCT, MRT) und die Minderperfusion des Lungenparenchyms (Szintigraphie, MSCT, MRT). Nach den bisherigen Empfehlungen gelten für die Diagnostik der chronischen Lungenembolie die Lungenszintigraphie (Ventilation/Perfusion) und die Pulmonalisangiographie als Methoden der ersten Wahl. Die MSCT und MRT (Angiographie/Perfusion) stellen technische Alternativen dar. Differenzialdiagnostisch sind andere Formen der pulmonalen Hypertonie abzugrenzen. Trotz medikamentöser und chirurgischer Therapiemaßnahmen (z. B. pulmonale Thrombendarterektomie) bleibt die Prognose der chronischen Lungenembolie ungünstig.
Abstract
In chronic pulmonary embolism branches of the pulmonary arterial tree remain partially or totally occluded. This may lead to pulmonary hypertension with the development of right ventricular hypertrophy as well as structural changes of pulmonary arteries. Imaging of chronic pulmonary embolism should prove vessel occlusions (pulmonary angiography, MSCT, MRI) and reduction of regional lung perfusion (lung scanning, MSCT, MRI). According to current guidelines ventilation-perfusion lung scanning and pulmonary angiography are still recommended as the methods of choice. MSCT and MRI provide technical alternatives which are helpful in differential diagnosis versus other types of pulmonary hypertension. In spite of medical and surgical measures (in rare cases pulmonary thromboendarterectomy) the prognosis of chronic pulmonary embolism remains unfavourable.
Literatur
Zipes DP, Libby P, Bonow RO, Braunwald E (eds) (2005) Braunwald’s heart disease: a textbook of cardiovascular medicine, 7th edn. Elsevier Saunders, Philadelphia
Wood KE (2002) Major pulmonary embolism: review of a pathophysiologic approach to the golden hour of hemodynamically significant pulmonary embolism. Chest 121: 877–905
Pengo V, Lensing AW, Prins MH et al. (2004) Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 350: 2257–2264
3. Weltkongress zur Pulmonal-Arteriellen Hypertension, 23.–25. Juni 2003, Venedig. Zusammenfassung in: J Am Coll Cardiol 2004 [suppl 43]: 1S–90S
Reiser M, Kuhn FP, Debus J (Hrsg) (2004) Radiologie. Thieme, Stuttgart
Rich S, Chomka E, Hasasa L et al. (1989) The prevalence of pulmonary hypertension in the United States. Adult population estimates obtained from measurements of chest roentgenograms from the NHANES II Survey. Chest 96: 236–241
Tunariu N, Gibbs SJ, Win Z et al. (2007) Ventilation-perfusion scintigraphy is more sensitive than multidetector CTPA in detecting chronic thromboembolic pulmonary disease as a treatable cause of pulmonary hypertension. J Nucl Med 48: 680–684
Prokop M, Galanski M, Schaefer-Prokop C, van der Molen AJ (Hrsg) (2007) Ganzkörper-Computertomographie. Spiral- und Multislice-CT. Thieme, Stuttgart
Wildberger JE, Niethammer MU, Klotz E et al. (2001) Multislice CT for visualisation of pulmonary embolism using perfusion weighted color maps. Rofo 173: 289–294
Herzog P, Wildberger JE, Niethammer M et al. (2003) CT perfusion imaging of the lung in pulmonary embolism. Acad Radiol 10: 1132–1146
Engelke C, Rummeny EJ, Marten E (2006) Mehrschicht-Spiral-CT bei vermuteter und inzidenteller akuter Lungenembolie: prognostischer Wert morphologischer Herzparameter. Rofo 178: 999–1006
Engelke C, Rummeny EJ, Marten E (2006) Acute pulmonary embolism on MDCT of the chest: prediction of cor pulmonale and short-term patient survival from morphologic embolus burgen. AJR Am J Roentgenol: 186: 1265–1271
Collomb D, Paramelle PM, van Strjen MJ et al. (2003) Severity assessment of acute pulmonary embolism: evaluation using helical CT. Eur Radiol 13: 1508–1514
Van der Meer RW, Pattynaname PM, van Strijen et al. (2005) Right ventricular dysfunction and pulmonary obstruction index at helical CT: prediction of clinical outcome during 3-month follow-up in patients with acute pulmonary embolism. Radiology 235: 798–803
Wintersperger BJ, Stäbler A, Seemann M et al. (1999) Evaluation of right heart load with spiral CT in patients with acute lung embolism. Rofo 170: 542–549
Ghaye B, Ghuysen A, Bruyere PJ et al. (2006) Can CT pulmonary angiography allow assessment of severity and prognosis in patients presenting with pulmonary embolism? What the radiologist needs to know. Radiographics 26: 23–39
Miller GA, Sutton GC, Kerr IH et al. (1971) Comparison of streptokinase and heparin in treatment of isolated acute massive pulmonary embolism. Br Med J 2: 681–684
Walsh PN, Greenspan RH, Simon M (1973) An angiographic severity index for pulmonary embolism. Circulation 47–48 [suppl II]: 101–108
Qanadli SD, El Hajjam M, Vicillard-Baron A (2001) New CT index to quantify arterial obstruction in pulmonary embolism: comparison with angiographic index and echocardiography. AJR Am J Roentgenol 176: 1415–1420
Mastora I, Remy-Jardin M, Masson P (2003) Severità of acute pulmonary embolism: evaluation of a new spiral CT angiographic score in correlation with echocardiographic data. Eur Radiol 13: 29–35
Kuriyama K, Gamsu G, Stern RG et al. (1984) CT-determined pulmonary artery diameters in predicting pulmonary hypertension. Invest Radiol 19: 16–22
Klima UP, Lee MY, Guerrero JL et al. (2002) Determinants of maximal right ventricular function: role of septal shift. J Thorax Cardiovasc Surg 123: 72–80
Stein P, Fowler S, Goodman L et al. (2006) Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 354: 2317–2327
Krüger S, Haage P, Hoffmann R et al. (2001) Diagnosis of pulmonary arterial hypertension and pulmonary embolism with magnetic resonance angiography. Chest 120: 1556–1561
Nikolaou K, Schoenberg SO, Attenberger U et al. (2005) Pulmonary arterial hypertension: diagnosis with fast perfusion MR imaging and high-spatial-resolution MR angiography – preliminary experience. Radiology 236: 694–703
Abolmaali N (Hrsg) (2006) Funktionelle Magnetresonanztomographie des Truncus pulmonalis. Lehmanns Media, Berlin
McGonn M, Gutterman D, Stehen V et al. (2004) Screening, early detection and diagnosis of pulmonary arterial hypertension. ACCP evidence-based clinical practice guidelines. Chest 126: 14S–34S
Darteville P, Fadel E, Mussot S et al. (2004) Chronic thromboembolic pulmonary hypertension. Eur Respir J 23: 637–648
Peacock A, Simonneau G, Rubin L (2006) Controversies, uncertainties and future research on the treatment of chronic thromboembolic pulmonary hypertension. Proc Am Thorac Soc 3: 608–614
Olschewski H, Hoeper M, Borst M et al. (2006) Diagnostik und Therapie der chronischen pulmonalen Hypertonie. Pneumologie 60: 749–771
Brett W, Jamieson SW, Zerkowski HR (2001) Pulmonale Thrombendarteriektomie. Schweiz Med Forum 34: 855–859
Interessenkonflikt
Es besteht kein Interessenskonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt wird oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Coppenrath, E., Herzog, P., Attenberger, U. et al. Chronische Lungenembolie – Radiologische Bildmorphologie und Differenzialdiagnose. Radiologe 47, 691–697 (2007). https://doi.org/10.1007/s00117-007-1531-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00117-007-1531-7