Notfallsonografie des Thorax

Zusammenfassung

Trotz der Limitationen, insbesondere dass Ultraschall lufthaltige Lunge nicht durchdringen kann, ist die Thoraxsonografie eine wichtige diagnostische Methode. Die Möglichkeit des Point-of-Care-Einsatzes und die fehlende Strahlenexposition sind dabei definitive Vorteile. Dieser Artikel soll einen ersten Eindruck vermitteln, wie man am besten wo schallt und was sonomorphologisch zu erwarten ist. Orientiert an Leitsymptomen wie Dyspnoe mit und ohne Fieber und Thoraxschmerzen mit und ohne Trauma werden die wichtigsten Pathologien für die Notfallsituation beschrieben.

Abstract

Despite the limitations (especially that ultrasound does not penetrate air containing lung tissue) ultrasound of the thorax is a very suitable method as a complementary or even primary diagnostic tool. Bedside availability and no radiation exposure are real advantages. However we always have to keep in mind that we are blind for deeper lung processes that do not have contact to the visceral pleura.

This article illustrates where and how to look for pathologies and what we have to expect in patients. According to symptoms such as dyspnea, dyspnea with fever and thorax pain with and without trauma, the sonographic morphology of important illnesses in emergency situation are described. The use of ultrasound can help to distinguish between differential diagnosis such as acute exacerbation of COPD vs. heart failure, pleuritis vs. pulmonary embolism, rip fracture vs. “simple” bone contusion and blunt chest trauma with or without pneumothorax.

Schlüsselwörter

Notfallsonografie - Thorax - Pneumothorax

Keywords

Emergency ultrasound - thorax - pneumothorax

• Literatur

• 1 Volpicelli G, Elbarbary M, Blaivas M et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012; 38: 577-591
• 2 Mathis G, Blank W, Reissig A et al. Thoracic ultrasound for diagnosing pulmonary embolism: a prospective multicenter study of 352 patients. Chest 2005; 128: 1531-1538
• 3 Volpicelli G, Cardinale L, Garofalo G, Veltri A. Usefulness of lung ultrasound in the beside distinction between pulmonary edema and exacerbation of COPD. Emerg Radiol 2008; 15: 145-151