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Radiologische Diagnostik von Thorax und Abdomen bei immunkompromittierten Patienten

Thoracic and abdominal imaging in immunocompromised patients

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Zusammenfassung

Weltweit ist eine steigende Zahl von Patienten von einer Immunsuppression betroffen. Das Krankheits- und Erregerspektrum kann bei diesen Patienten durch das häufige Vorkommen opportunistischer Infektionen deutlich von dem bei Immunkompetenten differieren. Zusätzlich können die klinischen Symptome unspezifisch sein, sodass der radiologischen Diagnostik eine Schlüsselfunktion im Management dieser Patienten zukommt. Bei immunkompromittierten Patienten ist die Lunge besonders häufig von Infektionen betroffen. Die Röntgenaufnahme des Thorax ist der Ausgangspunkt der Diagnostik, zeigt bei atypischen Erregern aber eine unzureichende Sensitivität und Spezifität, sodass die Computertomographie (CT) hier einen wesentlichen Stellenwert hat. Eine exakte Erregerspezifizierung ist leider auch mit der CT nicht möglich. Dennoch kann sie entscheidende Hinweise zur Differenzierung von viralen, bakteriellen und fungalen Infektionen sowie nichtinfektiösen Ursachen liefern. Auch bei der Bildgebung des Abdomens spielt die CT eine wesentliche Rolle und kommt zur Abklärung des akuten Abdomens und bei unklaren sonographischen Befunden zum Einsatz. Gleichzeitig können weitere diagnostische und therapeutische Maßnahmen, wie eine Probebiopsie oder eine Drainageanlage bei Abszedierung, durchgeführt werden.

Abstract

The number of patients with immunosuppression is rising worldwide. The spectrum of diseases and pathogens in these patients differs widely from that of immunocompetent patients due to frequent opportunistic infections. Symptoms are sometimes unspecific, and imaging plays a key role in the management of these patients. The lungs are a frequent site of infection in immunosuppressed patients. Chest X‑ray is the starting point for radiological diagnostics, but shows only limited sensitivity and specificity for infections with atypical pathogens. Thus, computed tomography (CT) is of great importance and allows a better distinction between viral, bacterial, or fungal infections, as well as other noninfectious diseases. Even with CT, however, is exact specification of the pathogen unfortunately not possible. CT is also the main diagnostic tool for assessment of the abdomen, particularly in patients presenting with acute abdomen or when sonographic findings are inconclusive. Moreover, CT allows diagnostic and therapeutic interventions such as percutaneous biopsies, or abscess and fluid drainage.

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  1. Institut für Diagnostische und Interventionelle Radiologie, Uniklink Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    J. R. Kroeger, D. Maintz & D.‑H. Chang

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  1. J. R. Kroeger
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Correspondence to D.‑H. Chang.

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J.R. Kroeger, D. Maintz und D.-H. Chang geben an, dass kein Interessenkonflikt besteht.

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Kroeger, J.R., Maintz, D. & Chang, D. Radiologische Diagnostik von Thorax und Abdomen bei immunkompromittierten Patienten. Med Klin Intensivmed Notfmed 114, 526–532 (2019). https://doi.org/10.1007/s00063-017-0331-8

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