Sonografie des Thorax zur Diagnostik und Verlaufsbeurteilung der Pneumonie

Zusammenfassung

Die Diagnostik der Pneumonie kann eine Herausforderung bedeuten, insbesondere hinsichtlich der Unterscheidung von unteren Atemwegsinfektionen und leichtgradigen Pneumonien, der Differenzialdiagnose der akuten respiratorischen Insuffizienz, der Diagnose von nosokomialen Pneumonien sowie im Falle eines Therapieversagens.

Die Sonografie des Thorax stellt eine diagnostische Methode dar, die gegenüber der konventionellen Röntgenthoraxaufnahme sowie der CT des Thorax Vorteile aufweist. So konnte gezeigt werden, dass sie der Röntgethoraxaufnahme in der Detektion von pneumonischen Konsolidierungen sogar überlegen ist. Da die meisten Pneumonien peripher liegen und die Pleura einbeziehen, können sonografisch trotz limitierter Eindringtiefe der Ultraschallwellen pneumonische Substrate in ca. 90% der Fälle identifiziert werden.

Ein gesicherter Stellenwert kommt der Sonografie des Thorax in der Diagnostik der ambulant erworbenen Pneumonie des Erwachsenen sowie der Kinder vor. Als besonders wertvoll erweist sie sich zudem in der Anwendung im Rahmen einer Point-of-care (POCUS)-Untersuchung, die auch das Herz mit einbezieht. Aber auch in der Diagnostik der nosokomialen Pneumonie sowie in der Evaluation des Therapieansprechens sowohl auf Normal- wie auf der Intensivstation weist sie ein erhebliches Potenzial auf.

Abstract

Diagnosis of pneumonia can be challenging, particularly the differential diagnosis of lower respiratory tract infection and pneumonia, acute respiratory failure, the diagnosis of nosocomial pneumonia and in case of treatment failure.

As compared to conventional chest radiography and CT of the scan, sonography of the chest offers advantages. It could be demonstrated that it was even superior to chest radiography in the identification of pneumonic consolidations. Since most pneumonias affect the lower lobes and include the pleura, pneumonic substrates could be identified in up to 90% of cases despite the limited penetration depth of lung ultrasound.

Sonography of the chest has become an established method in the diagnosis of both adult as well as in pediatric community-acquired pneumonia. In addition, it is particularly powerful when used within a point of care (POCUS) approach which also includes the evaluation of the heart. Finally, it appears to have significant potential also in the diagnosis of nosomomial pneumonia and in the evaluation of treatment response, both in the ward as in the ICU.

Schlüsselwörter

Pneumonie - Diagnose - Point-of-care (POCUS)-Sonografie - Konsolidierung - COVID-19

Keywords

pneumonia - diagnosis - point of care (POCUS) sonography - consolidation - COVID-19

Publication History

Received: 18 April 2024

Accepted after revision: 26 August 2024

Article published online:
25 September 2024

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