Zusammenfassung
Kindliche Lungenerkrankungen stellen ein häufiges klinisches Problem dar. Neben der klinischen Untersuchung und Laborparametern ist die radiologische Bildgebung eine wichtige Säule zur Festlegung der Behandlung. Die besondere Bedeutung des Strahlenschutzes bei Kindern bedingt eine veränderte Methodenwahl im Vergleich zu Erwachsenen. So haben Sonographie und MRT als ergänzende und/oder weiterführende Untersuchungsmethoden einen höheren Stellenwert als die Computertomographie im Erwachsenenalter. Häufigste Fragestellung ist der Verdacht/Ausschluss einer Pneumonie. Dazu ist eine Thoraxaufnahme im a.-p.- oder p.-a.-Strahlengang ausreichend, teils flankiert von der Thoraxsonographie, um bei Beschwerdepersistenz letztere als Verlaufsbildgebung einzusetzen. Die Sonographie wird zudem zur Abklärung auffälliger Strukturen im Thoraxraum (Thymus, Sequester) eingesetzt und kann zur definitiven Klärung führen. Der Röntgenthorax ist zudem ideal zur Abklärung typischer Anpassungsstörungen nach Geburt wie der transitorischen Tachypnoe („wet lung disease“) oder dem Surfactantmangel. Durchleuchtungsuntersuchungen werden zur Abklärung bei Aspirations- und/oder Ingestionsverdacht im Kleinkindalter eingesetzt. Die Computertomographie hat Bedeutung im Staging bzw. in der Nachsorge von Tumorerkrankungen. Technische Neuerungen (z. B. iterative Rekonstruktion) haben zu einer signifikanten Minderung der Strahlenexposition der CT geführt. Die MRT wird derzeit nur vereinzelt zur Abklärung bei Anlagestörungen (Sequester) oder Tumorerkrankungen eingesetzt, ihr Potenzial zur Darstellung funktioneller Aspekte (Perfusion und Ventilation) lässt aber einen breiteren Einsatz in Zukunft erwarten.
Abstract
Pediatric lung diseases are a common clinical problem. Besides the clinical examination and laboratory tests, imaging studies are the mainstay in the diagnostics of pediatric lung diseases. Thorough consideration of radiation protection based on optimized equipment also includes the protection of relatives and medical staff. The high impact of radiation protection in children necessitates a different choice of imaging modalities compared to adults. Ultrasound and magnetic resonance imaging (MRI) as adjunct or complementary imaging methods are of greater value than computed tomography (CT). The suspicion of pneumonia is the most common reason for chest imaging examinations in children. An anteroposterior or posteroanterior view chest X-ray is sufficient in most cases and sometimes in combination with ultrasound. The latter can also be used alone for follow-up examinations if the clinical presentation does not change. Additionally, ultrasound is applied to examine unclear structures seen on chest X-rays, such as the thymus or pulmonary sequestration in adjunct with color-coded duplex sonography. A chest X-ray is also the method of choice to examine the various forms of respiratory distress syndrome, such as wet lung disease or surfactant deficiency syndrome in newborns. Fluoroscopy is used in older children with suspected ingestion and/or aspiration of foreign bodies and CT is mostly used for staging and follow-up of thoracic and pulmonary structures in pediatric oncology. Recent technical advances, e.g. iterative reconstruction, have dramatically reduced the CT dosage. Apart from some indications (e.g. tumors and sequestration) MRI is rarely used in children; however, its potential for functional analyses (e.g. perfusion and ventilation) may increase the application in the near future.
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Interessenkonflikt. M. Beer und B. Ammann geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Beer, M., Ammann, B. Radiologische Diagnostik der kindlichen Lunge. Radiologe 55, 554–560 (2015). https://doi.org/10.1007/s00117-014-2775-7
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DOI: https://doi.org/10.1007/s00117-014-2775-7