Management des pulmonalen Abszesses: Diagnostik und Behandlung

Zusammenfassung

Ein Lungenabszess ist eine lokalisierte, meist bakterielle Einschmelzung des Lungengewebes. Für den Behandlungserfolg essenziell wichtig ist die Einordnung in eine an der Genese orientierte Klassifikation. Dies gelingt durch Anamnese, CT und Bronchoskopie. Grundpfeiler der konservativen Behandlung ist eine breite antibiotische Therapie. Interventionelle Maßnahmen wie transthorakale oder endobronchiale Abszessdrainage und die operative Therapie von der Videothorakoskopie über die VAC-Therapie bis zur anatomischen Resektion haben das Behandlungsspektrum erweitert.

Abstract

Lung abscess is a localized infectious pus-filled cavity of the lung tissue by viral, bacterial, mycotic or parasitic pathogens. Currently, there are different classifications, which are based primarily on the genesis and duration of symptoms. Important steps for diagnosis are in addition to clinical examination, laboratory and chest X-ray especially bronchoscopy with microbiological examinations and computed tomography. Treatment of lung abscesses continues to be a domain of conservative antibiotic therapy. The vast majority of cases can be cured with this. Interventional procedures such as transthoracic or endobronchial abscess drainage with subsequent irrigation can effectively support the healing process. Thoracic surgery is particularly important in cases of failure of conservative and interventional therapy as well as secondary abscesses on the basis of a lung carcinoma. Mostly anatomical resections are required. Alternatively, VAC therapy (vacuum-assisted closure therapy) may be considered in seriously ill, old, immunosuppressed, and multimorbid patients with complicated abscesses (e.g. perforation in the pleural cavity and sero-pneumothorax).

Kernaussagen

• Als Lungenabszess gilt eine lokalisierte infektiöse Einschmelzung des Lungengewebes durch virale, bakterielle, mykotische oder parasitäre Erreger.

• Aktuell existieren verschiedene Einteilungen, die sich in erster Linie an der Genese und der Zeitdauer des Bestehens orientieren.

• Im Vordergrund der Diagnostik stehen neben klinischer Untersuchung, Labor und Röntgen des Thorax insbesondere die Bronchoskopie mit Sekretgewinnung, mikrobiologische Untersuchungen und die Computertomografie.

• Die Behandlung der Lungenabszesse ist weiterhin eine Domäne der konservativen antibiotischen Therapie. Die überwiegende Mehrheit der Fälle kann hiermit geheilt werden.

• Interventionelle Maßnahmen wie die transthorakale oder endobronchiale Abszessdrainage mit anschließender Spülung können den Heilungsprozess wirksam unterstützen.

• Thoraxchirurgische Operationen kommen insbesondere bei Versagen der konservativen und interventionellen Therapie in Betracht sowie bei sekundären Abszessen auf dem Boden eines Lungenkarzinoms.

• In der Regel sind anatomische Resektionen erforderlich.

• Alternativ kann bei schwer kranken, alten, immunsupprimierten und multimorbiden Patienten mit kompliziertem Abszess (z. B. mit Perforation in die Pleurahöhle und Sero-Pneumothorax) eine VAC-Therapie erwogen werden.

Schlüsselwörter

Lungenabszess - chirurgische Behandlung - Lungenresektion - antibiotische Behandlung - interventionelle Drainage

Key words

lung abscess - surgical technique - pulmonary resection - antibiotic strategies - interventional drainage

Publikationsverlauf

Artikel online veröffentlicht:
01. Dezember 2020

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