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Relevante Nebenbefunde im CT

Ein unterschätzter Aspekt der modernen Lungenemboliediagnostik

Relevant secondary findings in CT

An underestimated benefit of diagnostics in patients suspected of pulmonary embolism

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Zusammenfassung

Hintergrund

Die sichere Erkennung einer Lungenembolie (LE) gilt für Notfalleinrichtungen seit langer Zeit als großes Problem. Die 2008 implementierten und 2014 aktualisierten ESC-Leitlinien zur LE empfehlen ein Vorgehen, welches eine niederschwellige CT-Indikation mit einem hohen Anteil von LE-Ausschlussuntersuchungen vorsieht.

Methoden

Die vorliegende Arbeit untersucht retrospektiv bei 492 Patienten mit Verdacht auf LE die Inzidenz und klinische Bedeutung von Nebenbefunden im CT. Diese könnten – in Ergänzung zur LE-Diagnostik – einen wichtigen zusätzlichen Informationsgewinn bedeuten.

Ergebnisse

Bei 59 Patienten (12 %) wurde eine LE nachgewiesen. In 203 Fällen (41 %) fanden sich Nebenbefunde. Besonders häufig waren die Befunde Struma, Pleuraerguss, pneumonieverdächtiges Infiltrat, neoplasieverdächtige Raumforderung und Lymphknotenvergrößerung; seltener vertreten waren die Befunde pulmonalvenöse Stauung, Perikarderguss, Rippenfraktur und Pneumothorax.

Schlussfolgerung

Die Daten zeigen einen hohen Prozentsatz an Nebenbefunden. Die dargestellten Erkrankungen sind unterschiedlich prognostisch bedeutsam und wären teilweise durch alternative Methoden darstellbar gewesen. Dennoch ist ein Teil der CT-Nebenbefunde mit einem wesentlichen Informationsgewinn und der Notwendigkeit weiterer Nachfolgeuntersuchungen verbunden.

Abstract

Background

Reliable detection of pulmonary embolism (PE) is considered a major challenge for emergency facilities. The 2008 published and 2014 updated ESC guidelines for PE recommend a strategy of low-threshold CT indication with a high proportion of examinations to exclude PE.

Methods

The cases of 492 patients with suspected PE were retrospectively analyzed with regard to the incidence of secondary findings in the CT. Secondary findings were assessed in order to evaluate possible benefits of the CT scan for the patients in addition to the PE diagnostics.

Results

In 59 out of 492 patients PE was detected; in 203 of these patients (41 %) secondary findings were identified. Goiter, pleural effusion, infiltration suspected of pneumonia, tumor suspected of neoplasia, and enlarged lymph nodes were particularly frequent. Pulmonal congestion, pericardial effusion, rib fracture, and pneumothorax were rare.

Conclusions

Our data show a high proportion of secondary findings in the context of CT diagnostics in patients with suspected pulmonary embolism. The prognostic value of these findings varies. Only a part of these findings would have been detectable by alternative diagnostic methods. Generally, the additional information gained by secondary findings in CT seems to be useful in order to identify further examinations in addition to PE diagnostics.

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Authors and Affiliations

  1. Zentrale Notaufnahme, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim, Deutschland

    J. Grüttner, M. Bolte & T. Walter

  2. Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Heidelberg, Deutschland

    T. Viergutz

  3. Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Heidelberg, Deutschland

    T. Henzler & S. Sudarski

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  1. J. Grüttner
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Correspondence to J. Grüttner.

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Interessenkonflikt

J. Grüttner, T. Viergutz, M. Bolte, T. Henzler, S. Sudarski und T. Walter geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag enthält eine ausschließlich retrospektive Auswertung bereits vorhandener klinischer Befunde und wurde mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt.

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Redaktion

M. Fischer, Göppingen

K.-G. Kanz, München

W. Schreiber, Wien

F. Walcher, Magdeburg

J. Grüttner und T. Viergutz sind gleichberechtigte Erstautoren

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Grüttner, J., Viergutz, T., Bolte, M. et al. Relevante Nebenbefunde im CT. Notfall Rettungsmed 18, 222–226 (2015). https://doi.org/10.1007/s10049-015-0005-0

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  • DOI: https://doi.org/10.1007/s10049-015-0005-0

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