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Chronische Lungenembolie – Radiologische Bildmorphologie und Differenzialdiagnose

Chronic pulmonary embolism – radiological imaging and differential diagnosis

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.

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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

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  • DOI: https://doi.org/10.1007/s00117-007-1531-7

Schlüsselwörter

  • Chronische Lungenembolie
  • Pulmonale Hypertonie
  • Rechtsherzbelastung
  • Mosaikperfusion

Keywords

  • Chronic pulmonary embolism
  • Pulmonary hypertension
  • Right ventricular hypertrophy
  • Mosaic perfusion