Extrapulmonale Tuberkulose: Die radiologische Bildgebung eines fast vergessenen Verwandlungskünstlers

Zusammenfassung

Die Tuberkulose (TB) rangiert nach wie vor unter den Infektionserkrankungen mit den weltweit höchsten Raten vermeidbarer Morbidität und Mortalität. Nur in den hochindustrialisierten Ländern, so auch in Deutschland mit 4400 Fällen im Jahr 2009 entsprechend einer Inzidenz von 5,5 pro 100 000 Einwohnern, ist ein anhaltend rückläufiger Trend zu beobachten. Parallel dazu nehmen die Konfrontation mit dieser Erkrankung und die klinische Erfahrung ab. Grundsätzlich kann die Tuberkulose jedes Organ befallen, in ca. 80 % der 2008 in Deutschland gemeldeten Fälle war die Lunge betroffen, in 20 % wurde eine extrapulmonale Manifestation registriert. Der Befall der Lymphknoten ist am häufigsten mit einem Anteil von ca. 50 % aller extrapulmonalen Tuberkulosen, gefolgt von der Pleura 18 %, des Urogenitaltraktes 13 %, der Knochen und Gelenke 6 %, des Gastrointestinaltraktes 6 %, des ZNS 3 % und der Wirbelsäule 3 %. Symptome wie Fieber, Nachtschweiß und Gewichtsverlust, sind unspezifisch und können gänzlich fehlen. Ziel der Übersichtsarbeit ist es, diese zunehmend in Vergessenheit geratende Erkrankung mit ihren vielfältigen radiologischen Manifestationen erneut ins Bewusstsein zu rücken und auf die klinisch-epidemiologischen und demografischen Faktoren hinzuweisen, welche den Verdacht auf eine Tuberkulose lenken.

Abstract

Tuberculosis (TB) continues to be one of the infectious diseases with the world’s highest rates of avoidable morbidity and mortality. A continuing downward trend has only been observed in highly industrialized countries, including Germany with 4,400 cases in the year 2009 representing an incidence of 5.5 per 100,000 persons. At the same time, the exposure to this patient group and the clinical experience are decreasing. Tuberculosis may affect any organ. The lung was the manifestation site in 80 % of cases, and extrapulmonary manifestations were recorded in 20 % of cases in Germany in the year 2008. Lymph node involvement is most common with a rate of approximately 50 % of all extrapulmonary cases followed by the pleura in 18 % of cases, genitourinary tract in 13 % of cases, bones and joints in 6 % of cases, gastrointestinal tract in 6 % of cases, the central nervous system in 3 % of cases and the spine in 3 % of cases. Symptoms like fever, night sweats and weight loss are non-specific and may be absent. The aim of the review is to raise awareness of this disease, which is increasingly falling into oblivion, with its various radiological manifestations and to point out clinical-epidemiological and demographic factors that raise suspicion of tuberculosis.

Key words

tuberculosis - extrapulmonary - X-ray - CT - MRI - differential diagnosis

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