Extraartikuläre Sonografie

Zusammenfassung

Die Sonografie extraartikulärer Körperregionen bei rheumatologischen Erkrankungen ist vielgestaltig. Gichttophi sind echoreich mit partieller oder totaler dorsaler Schallauslöschung im Gegensatz zu echoarmen, meist besser abgrenzbaren Rheumaknoten. Ein Erythema nodosum stellt sich sonografisch homogen und echoreicher als das benachbarte FettgeWebe dar. Innere Organe sowie Lymphknoten sind häufig bei rheumatischen Erkrankungen beteiligt. Die Speicheldrüsen zeigen beim Sjögren-Syndrom ein inhomogenes, echoarmes Muster. Phlebothrombosen können sonografisch gut von rupturierten Bakerzysten abgegrenzt Werden. Bei Vaskulitiden großer Gefäße zeigt sich in der Akutphase eine charakteristische echoarme WandschWellung, die an den Temporalarterien in zWei bis drei Wochen unter Glukokortikoidtherapie verschWindet. Bei der Riesenzellarteriitis großer Gefäße im Bereich der proximalen Armarterien, insbesondere an der Arteria axillaris, besteht sie länger. Die Sonografie der Fingerarterien hilft in der Differenzialdiagnostik des Raynaud-Phänomens. Verengungen, chronische und akute Verschlüsse lassen sich bei Kollagenosen und Vaskulitiden darstellen.

Summary

Ultrasound alloWs to examine multiple anatomic areas in rheumatology. Gout tophi are hyperechoic With partial or total dorsal shadoWing in contrast to rheumatic nodules that appear hypoechoic With definable margins. An erythema nodosum is more hyperechoic and homogeneous than the adjacent normal fat tissue. Rheumatic diseases involve many organs as Well as lymph nodes. Salivary glands are inhomogeneous and hypoechoic in Sjögren’s syndrome. Ultrasound alloWs to easily distinguish phlebothrombosis from ruptured Baker’s cysts. Large-vessel vasculitides are characterized by homogenous Wall sWelling that disappears Within tWo to three Weeks With corticosteroid therapy. In large-vessel giant cell arteritis that is defined by vasculitis of the proximal arm arteries, in particular of the axillary arteries, the Wall sWelling remains for a longer time despite treatment. Ultrasound of finger arteries aids in the differential diagnosis of Raynaud’s phenomenon. Vascular narroWing, chronic and acute occlusions occur in vasculitis and connective tissue disease.

Schlüsselwörter

Ultraschall - Sjögren-Syndrom - Riesenzellarteriitis - Gicht

Keywords

Ultrasonography - Sjögren’s syndrome - giant cell arteritis - gout

• Literatur

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