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MMW - Fortschritte der Medizin

, Volume 160, Supplement 4, pp 12–17 | Cite as

Wichtige Differentialdiagnosen von Lungeninfiltraten bei hämatologischen Patienten

  • Igor-Wolfgang Blau
  • Werner J. Heinz
  • Stefan Schwartz
  • Hans-Peter Lipp
  • Philippe Schafhausen
  • Georg Maschmeyer
Article
  • 70 Downloads

Zusammenfassung

Hintergrund

Pulmonale Komplikationen treten bei hämatologischen Patienten häufig auf.

Methode

In einer Übersichtsarbeit wird das Ergebnis einer Diskussion zusammengefasst, die während eines Expertentreffens zum Thema Lungeninfiltrate stattfand.

Ergebnisse und Schlussfolgerungen

Die häufigsten Ursachen von Lungeninfiltraten bei hämatologischen Patienten sind bakterielle Infektionen, aber auch Virusinfektionen verursachen, zum Teil mit relevanter saisonaler Schwankung, einen wichtigen Anteil pulmonaler Infiltrate. Für beide Erregergruppen stellt die mikrobiologische Untersuchung von Materialien des Respirationstrakts (möglichst bronchoalveoläre Lavage, BAL) die wichtigste Diagnostik dar. Insbesondere bei länger anhaltender (> 7 Tage) Neutropenie steigt die Wahrscheinlichkeit, dass Infiltrate durch Pilzinfektionen bedingt sind. Nichtinfektiöse Ursachen, z. B. durch Medikamente bedingte Infiltrate, sind differentialdiagnostisch grundsätzlich zu berücksichtigen, dürfen jedoch eine schnelle Diagnostik und adäquate antimikrobielle Therapie nicht verzögern.

Schlüsselwörter

Galactomannan Glucan Bildgebung Leukämie Lymphom Myelom 

Pulmonary infiltrates in haematological patients

Background

Pulmonary complications are frequent in haematologic patients.

Method

This review article summarizes the outcome of a discussion that took place during an expert meeting on the subject of pulmonary infiltrates.

Results and Conclusions

The most common causes of pulmonary infiltrates in haematologic patients are bacterial infections. Viral infections are subject to relevant seasonal variations, but they may also cause an important proportion of pulmonary infiltrates. Microbiological examination of respiratory tract material (if possible, bronchoalveolar lavage, BAL) is the most important diagnostic procedure. Particularly in the case of prolonged (> 7 days) neutropenia, the likelihood of infiltrates being caused by fungal infections increases. For a differential diagnosis, however, also non-infectious causes, e.g. drug-induced infiltrates, have to be taken into consideration. The diagnostic workup, however, should not delay a timely start of an adequate antimicrobial therapy.

Keywords

galactomannan glucan imaging leukaemia lymphoma myeloma 

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • Igor-Wolfgang Blau
    • 1
    • 7
  • Werner J. Heinz
    • 2
  • Stefan Schwartz
    • 3
  • Hans-Peter Lipp
    • 4
  • Philippe Schafhausen
    • 5
  • Georg Maschmeyer
    • 6
  1. 1.Medizinische Klinik für Hämatologie, Onkologie und Tumorimmunologie, Leitender Oberarzt KnochenmarktransplantationCampus Virchow Klinikum der Charité — Universitätsmedizin BerlinBerlinDeutschland
  2. 2.Medizinische Klinik und Poliklinik IIUniversitätsklinikum WürzburgWürzburgDeutschland
  3. 3.Medizinische Klinik für Hämatologie, Onkologie und TumorimmunologieCampus Benjamin Franklin der Charité — Universitätsmedizin BerlinBerlinDeutschland
  4. 4.Universitätsklinikum TübingenTübingenDeutschland
  5. 5.Zentrum für Onkologie, II. Medizinische Klinik und PoliklinikUKE HamburgHamburgDeutschland
  6. 6.Klinik für Hämatologie, Onkologie und PalliativmedizinKlinikum Ernst von Bergmann gemeinnützige GmbHPotsdamDeutschland
  7. 7.Klinik für Hämatologie, Onkologie und TumorimmunologieCampus Virchow Klinikum der Charité — Universitätsmedizin BerlinBerlinDeutschland

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