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Pleura

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Bildatlas der Lungensonographie

Zusammenfassung

Trotz der ultraschall-physikalischen Grenzen sind ca. 70 % der Pleurafläche sonographisch besonders kostal und diaphragmal erreichbar. Die normale Pleura parietalis lässt sich darstellen und von umschriebenen und diffusen pathologischen Verdickungen abgrenzen. Die normale Pleura visceralis geht in der Totalreflexion an der Oberfläche der lufthaltigen Lunge unter. Der sonographische Pleuraergussnachweis ist ab 5 ml möglich und wesentlich sensitiver als im Thoraxröntgen, besonders im Liegen; falschpositive Befunde kommen nicht vor. Die Ergussmengenschätzung ist genauer. Exsudate sind in ca. einem Drittel echogen, Pleuraverdickungen, knotige Pleuraveränderungen, Septen und Kammerungen kommen nur bei Pleuraexsudaten vor. Transsudate sind immer echofrei. Pleurametastasen sind typischerweise echoarm und knotig-polypoid. Ein Rückschluss auf den Primärtumor ist nur histologisch möglich. Die Ausdehnung von Pleuramesotheliomen ist sonographisch nahezu gleich gut abgrenzbar wie in der Computertomographie, teilweise mit höherer Spezifität. Eine sonomorphologische Differenzierung zwischen Mesotheliom, Karzinose und Schwarte kann schwierig sein. Ein Pneumothorax ist sonographisch sicher nachweisbar. Morphologische und vor allem funktionelle Zwerchfelldiagnostik ist sonographisch sicher und überzeugend.

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  1. Leitender Oberarzt der Medizinischen Klinik IV Gastroenterologie/Onkologie, Klinikum Sindelfingen/Böblingen Kliniken Böblingen, Bunsenstraße 120, 71032, Böblingen

    Dr. Joachim Reuß OA

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  1. Internistische Praxis, Rankweil, Österreich

    Gebhard Mathis

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Reuß, J. (2016). Pleura. In: Mathis, G. (eds) Bildatlas der Lungensonographie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-47536-2_3

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