Bildgebende Diagnostik gynäkologischer Notfälle

Zusammenfassung

Das akute Abdomen ist ein häufiges Krankheitsbild in der Notfalldiagnostik. Pathologische Veränderungen der weiblichen Genitalorgane spielen dabei eine wichtige Rolle. Gynäkologische Notfälle gefährden die Fertilität und sind potenziell lebensbedrohlich. Bei der Diagnostik sind viele Differenzialdiagnosen je nach Alter der Patientin und einer eventuellen Schwangerschaft zu beachten. Insbesondere akute gastrointestinale Beschwerden lassen sich in der klinischen Untersuchung oft nicht von gynäkologischen Notfällen unterscheiden. Die Bildgebung leistet hier einen wesentlichen Beitrag zur Einengung der Differenzialdiagnose, zur Therapieentscheidung und zum Therapiemonitoring. Im vorliegenden Übersichtsartikel soll der zentrale Stellenwert der Bildgebung im Rahmen häufiger gynäkologischer Notfälle erörtert werden.

Abstract

Acute abdominal pain related to the female genital organs is frequently encountered in the emergency department. Gynecological emergencies are diseases of the female reproductive system that are potentially life-threatening and peril the sexual function and fertility. In the diagnostic work-up of acute abdominal pain, a wide variety of differential diagnoses needs to be considered depending on the age of the patient and a concomitant pregnancy. There is significant clinical overlap with gastrointestinal emergencies. Therefore, imaging plays a key role in diagnosing the cause of the pain and the planning of the therapy. The aim of this review is to illustrate the significant role of imaging in frequently encountered gynaecologic emergencies.

Kernaussagen

• Wenn die CT bei bei Kindern, Schwangeren oder Frauen im gebärfähigen Alter zum Einsatz kommt, sollte die Strahlendosis besonders beachtet werden. Es gilt das ALARA-Prinzip, d. h. die Dosis sollte „as low as reasonably achievable“ sein.

• Die MRT dient zur Abklärung subakuter Krankheitsbilder und unklarer sonografischer Befunde. Bei eindeutiger Indikation und positivem Nutzen-Risiko-Verhältnis kann die MRT auch bei Schwangeren durchgeführt werden.

• Der Hämatometrokolpos (distendierter, blutgefüllter Uterus und Vagina) ist in zwei Drittel aller Fälle durch die Hymenalatresie verursacht. Nach der initialen Abklärung mittels Ultraschall sollte eine assoziierte Nierenfehlbildung und eine Hydronephrose ausgeschlossen werden.

• Die EUG ist der häufigste Notfall in der frühen Schwangerschaft und manifestiert sich i. d. R. in der Tuba uterina. Risikofaktoren sind u. a. „pelvic inflammatory disease“, Endometriose und Voroperationen. Ultraschallzeichen sind ein „blob-sign“ und ein „tubal ring-sign“. Die MRT dient lediglich zur Abklärung unklarer Fälle.

• Leiomyome sind die häufigsten gynäkologischen Neoplasien. Die rote Degeneration des Leiomyoms ist eine wichtige Differenzialdiagnose des akuten Abdomens während der Schwangerschaft. Die Torsion eines Leiomyoms kann ebenfalls eine Ursache für ein akutes Abdomen sein.

Keywords

Emergency - gynaecology - imaging - ovary - uterus

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