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DOI: 10.1055/s-2003-812528
Parapneumonischer Erguss und Pleuraempyem - aktuelle Aspekte zu Einteilung, Diagnose und Therapie
Parapneumonic Effusion and Pleural Empyema - Topical Aspects of Classification, Diagnosis and TreatmentPublication History
Eingang: 31. Juli 2003
Nach Revision angenommen: 31. Oktober 2003
Publication Date:
12 February 2004 (online)
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Zusammenfassung
Parapneumonische Pleuraergüsse sind nicht selten und können bei Patienten mit bakteriellen Pneumonien in ca. 40 - 50 % der Fälle beobachtet werden. Dennoch sind Diagnostik und therapeutisches Vorgehen ausgesprochen variabel und bis jetzt kaum durch evidenzbasierte Daten gesichert. Die Einteilung der parapneumonischen Pleuraergüsse kann nach morphologischen, chemischen und bakteriologischen Kriterien erfolgen. In Abhängigkeit vom Schweregrad reichen differenzialtherapeutische Verfahren vom Verlauf ohne Intervention über Entlastungspunktion und Drainageanlage mit oder ohne lokale Fibrinolyse bis zu den chirurgischen Verfahren VATS und offene Exploration. In der vorliegenden Übersicht wird versucht, die aktuellen Aspekte der Einteilung, Diagnostik und Therapie zusammenzufassen und Schlussfolgerungen für die tägliche Praxis zu ziehen.
Abstract
Parapneumonic effusions can be diagnosed in about 40 - 50 % of patients with bacterial pneumonia, and therefore should be considered as a frequent condition. Despite their prevalence, there is limited consensus about diagnostic pathways and therapeutic procedures due to the lack of evidence-based data available. The classification of parapneumonic effusions is based on morphological, chemical and bacteriological criteria. Dependent on the complexity of the effusion, available management approaches include observation without intervention, thoracentesis, chest tube drainage with or without local fibrinolysis and the surgical options VATS and thoracotomy. This overview summarizes the actual aspects of classification, diagnosis and treatment of the parapneumonic effusion and draws conclusions for the daily management of this condition.
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Martin Kolditz
Medizinische Klinik und Poliklinik I (Direktor: Prof. Dr. med. G. Ehninger) · Universitätsklinikum Carl Gustav Carus
Fetscherstr. 74
01307 Dresden