Prognostische Bedeutung pleuraler Defekte in der Lunge bei Patienten mit tiefer Beinvenenthrombose: Eine prospektive sonographische Studie bei 211 Patienten

Einleitung: Die klinische Diagnose einer Lungenembolie (LE) wird lediglich in 20-30% vor dem Tode diagnostiziert, d.h. zwei Drittel aller Lungenembolien werden vom Kliniker nicht diagnostiziert. Die Pulmonalisarterienangiographie war lange Zeit der diagnostische Goldstandard in der Diagnostik der...

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Bibliographic Details
Main Author: Egbring, Jörg
Contributors: Görg, C. (Prof. Dr.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2005
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Table of Contents: Introduction: In only 20-30% of cases a lung embolism (LE) is clinically diagnosed pre mortal - this means two thirds of all lung embolisms are not diagnosed. For a long time pulmonary angiography was the diagnostic "gold" standard for diagnosing the LE. Pulmonary angiography is currently replaced by spiral computer tomography as the diagnostic standard. Sonography is not mentioned in the "guidelines". Because of the acoustic-physical conditions in the lung sound waves are nearly completely reflected. Sonographically the pleura is an hyperechoic sharp reflex ban. After the occlusion of a peripheral sub-artery due to oxygen deficiency the surfactant-production collapses and interstitial liquid and erythrocytes enter the alveolar lumen (early infarction). Sonographically "pleural defects" can be identified. The embolus itself can not be displayed sonographically. In case of a large scale emboli the lung periphery is being provided by collaterals of the "a. bronchiales". Because of defragmentation of the central embolus and leachate of thrombotic material in the periphery early infarction that can be discovered with a sonography are created quite often. Objective: Examination of the diagnostical significance of the sonography in the diagnosis of pulmonary embolism through detection of pleural defects as well as examining the clinical /prognostic importance of these pleural defects. Material and methods: n = 211 patients with a sonographically diagnosed deep vein thrombosis (DVT) were accepted for this study. Subsequently, all patients thorax was prospektiv sonographically examined. The patients were then split up into three groups: 1. Clinically asymptomatic for a LE; 2. Clinically symptomatic for a LE; 3. Clinically symptomatic for a LE with medical attendance in an intensive care unit. Results: 1. With 40.3% of the patients in the 1st group "pleural defects" were diagnosed, which can be associated with peripheral "signal embolisms". The comparison of survival curves for patients with and without "pleural defects" was identical and statistically not significant. Conclusion: For Patients that are clinically asymptomatic for a LE with a DVT, "pleural defects" (signal embolisms) are without any clinical relevance. 2. 82% of patients with a suspected LE did have pleural defects, in terms of a LE. These results are comparable and in line with other studies. 3. 22% of all patients in the study were not treated in accordance with the general guidelines for treating a DVT or a LE. The comparison of survival curves "treatment according to guidelines" and "treatment not according to guidelines" was statistically significant.