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Bildgebende Verfahren zur Diagnostik der akuten Lungenarterienembolie

Imaging procedures for the diagnosis of acute pulmonary embolism

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Zusammenfassung

Der Einsatz bildgebender Verfahren in der Diagnostik der Lungenarterienembolie (LAE) erfolgt in Zusammenschau mit der klinischen Vortestwahrscheinlichkeit und Laborparametern wie D-Dimeren und BNP bzw. Troponin. Primäres diagnostisches Instrument ist die Spiralcomutertomographie, idealerweise in Mehrzeilentechnik. Auch die Lungenszintigraphie hat eine hohe Aussagekraft, wenn eindeutige Befunde erhoben werden. Ist eine LAE wahrscheinlich, so kann die Diagnose mittels Duplexsonographie erhärtet werden. Thoraxsonographie, Magnetresonanztomographie und Echokardiographie sind als komplementäre diagnostische Methoden anzusehen. Bei Verdacht auf massive LAE kann eine Thrombolyse allein aufgrund echokardiographischer Zeichen der akuten Rechtsherzbelastung umgehend begonnen werden.

Abstract

The use of imaging techniques in the diagnosis of pulmonary embolism (PE) is based on the judgement of clinical probability and laboratory parameters such as D-dimers and B-type natriuretic peptide or troponins. The primary imaging modality is spiral CT angiography, preferably using multislice techniques. The accuracy of isotope lung scanning is high if considered diagnostic by standardised criteria. Unless the clinical probability is low, PE can be diagnosed by venous ultrasonography. Thoracic ultrasound studies, MR angiography and echocardiography are considered as complementary diagnostic tools. If massive PE is suspected, thrombolytic therapy can be initiated solely based on the echocardiographic finding of right ventricular dysfunction.

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  1. Medizinische Klinik I, Caritas-Krankenhaus Bad Mergentheim, 97980, Uhlandstraße 7, Bad Mergentheim, Deutschland

    M.M. Borst

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Borst, M. Bildgebende Verfahren zur Diagnostik der akuten Lungenarterienembolie. Pneumologe 4, 13–23 (2007). https://doi.org/10.1007/s10405-006-0130-z

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