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Management von Pleuraerkrankungen

Management of pleural diseases

  • CME Zertifizierte Fortbildung
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Der Pneumologe Aims and scope

Zusammenfassung

Pleuraerkrankungen sind häufig, Hauptmanifestation ist der Pleuraerguss. Das Spektrum der Krankheiten, die mit einem Pleuraerguss einhergehen können, ist sehr groß. Pathophysiologisch ist das Gleichgewicht zwischen Produktion und Resorption von Pleuraflüssigkeit gestört. Unterschieden wird zwischen Transsudaten (am häufigsten kardial bedingt) und Exsudaten (vorwiegend entzündlich oder tumorös bedingt). Die Diagnostik der Pleuraergüsse richtet sich zunächst nach der wahrscheinlichen Ätiologie, die häufig bereits klinisch eruierbar ist. Weitere diagnostische Maßnahmen beinhalten bildgebende Verfahren (z. B. die CT-Angiographie bei Verdacht auf Lungenembolie) sowie die Untersuchung der Pleuraflüssigkeit und ggf. im nächsten Schritt Pleurabiopsien, vorzugsweise mittels der internistischen Thorakoskopie (Pleuroskopie). Therapeutische Ziele bei Patienten mit Pleuraerguss sind die Heilung der Grundkrankheit (wenn möglich), die Linderung der Beschwerden (Schmerzen, Atemnot), die Vermeidung funktionseinschränkender Pleuraschwarten sowie die Rezidivprophylaxe (z. B. mittels Pleuradrainage und Pleurodese).

Abstract

Pleural diseases are very common. The main manifestation is pleural effusions. The spectrum of diseases causing pleural effusions is wide. Pathophysiologically, the balance between formation and resorption of pleural fluid is disturbed. Transudates (most frequently cardiac) need to be differentiated from exudates (mainly inflammatory or malignant). The diagnostic approach depends first of all on the most likely etiology which is often already clinically apparent. Further diagnostic steps include imaging techniques, e.g. computed tomography angiography (angio-CT) in suspected pulmonary embolism as well as examination of the pleural fluid and, if needed, biopsy of the pleura, preferably by medical thoracoscopy (pleuroscopy). Therapeutic aims in patients with pleural effusions are the cure of the underlying disease (if possible), palliation of symptoms (pain and dyspnea), prevention of pleural fibrosis with reduced pulmonary function and prevention of recurrences (e.g. by pleural drainage and/or pleurodesis).

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Einhaltung ethischer Richtlinien

Interessenkonflikt. W. Frank und R. Loddenkemper geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Lungenklinik Amsee, Amsee 6, 14192, Waren/Müritz, Deutschland

    W. Frank

  2. -, Hertastr. 3, 14169, Berlin, Deutschland

    R. Loddenkemper

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  1. W. Frank
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  2. R. Loddenkemper
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Correspondence to W. Frank or R. Loddenkemper.

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Frank, W., Loddenkemper, R. Management von Pleuraerkrankungen. Pneumologe 11, 177–189 (2014). https://doi.org/10.1007/s10405-014-0777-9

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