Parapneumonischer Erguss und Pleuraempyem - aktuelle Aspekte zu Einteilung, Diagnose und Therapie

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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