Advertisement

Pleura

Chapter
  • 2.3k Downloads

Zusammenfassung

Nach der Thoraxwand ist die Pleura die sonographisch am leichtesten erreichbare und darstellbare Struktur am Thorax. Durch geeignete Untersuchungstechnik lässt sich die gesamte Pleura costalis und Pleura diaphragmatica erfassen. Die hinter Rippen verborgene viszerale Pleura ist durch Atemmanöver in Interkostalräume verschiebbar. Von jugulär her ist auch das obere vordere Mediastinum mit seinen Pleuraanteilen darstellbar. Die unteren und hinteren mediastinalen und die paravertebralen Pleuraabschnitte sind sonographisch transthorakal meist nicht zu erreichen. Nach Schätzungen anhand computertomographischer Transversalschnitte des Thorax kann man mindestens 60–70% der Pleurafläche sonographisch darstellen (Reuß 1996). Die meisten Erkrankungen der Pleura betreffen vornehmlich die kostalen und diaphragmalen Pleuraabschnitte und die Lungenspitzen. Der Wert der Farbduplexsonographie der Pleura ist zwar noch nicht ausreichend evaluiert, aber Farbduplexsonographie, Spektraldopplersonographie und kontrastverstärkte Sonographie erobern sich einen Platz bei der Differenzialdiagnose von Raumforderungen auf Pleuraniveau.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. Abouzgheib W, Bartter T, Dagher H, Pratter M, Klump W (2009) A prospective study of the volume of pleural fluid required for accurate diagnosis of malignant pleural effusion. Chest 135:999–1001CrossRefPubMedGoogle Scholar
  2. Adams RF, Gray W, Davies RJ, Gleeson FV (2001) Percutaneous image-guided cutting needle biopsy of the pleura in the diagnosis of malignant mesothelioma. Chest 120: 1798–1802CrossRefPubMedGoogle Scholar
  3. Baber CE, Hedlund LW, Oddson TA, Putman CE (1980) Differentiating empyemas and peripheral pulmonary abscess. Radiology 135: 755–758PubMedGoogle Scholar
  4. Balik M, Plasil P, Waldauf P et al. (2006) Ultrasound estimation of volume of pleural fluid in mechanically ventilated patients. Intensive Care Med 32:318–321CrossRefPubMedGoogle Scholar
  5. Bedetti G, Gargani L, Corbisiero A et al. (2006) Evaluation of ultrasound lung comets by hand-held echocardiography. Cardiovasv Ultrasound 4:34CrossRefGoogle Scholar
  6. Belaabidia B, Sellami S, Benelkhayat R et al. (2006) Le léiomyosarcome diaphragmatique: revue de la Litterature, à propos d’une observation. Cancer Radiother 10:137–141PubMedGoogle Scholar
  7. Bittner RC, Schnoy N, Schönfeld N et al. (1995) Hochauflösende Magnetresonanztomographie (HR-MRT) von Pleura und Thoraxwand: Normalbefund und pathologische Veränderungen. Fortschr Roentgenstr 162: 296–303CrossRefGoogle Scholar
  8. Börner N, Kelbel C, Lorenz J et al. (1987) Sonographische Volumetrie und Drainage von Pleuraergüssen. Ultraschall Klin Prax 2: 148–152Google Scholar
  9. Boutin C, Rey F (1993) Thoracoscopy in pleural malignant mesothelioma: a prospective study of 188 consecutive patients. I. Diagnosis. Cancer 72: 389–393CrossRefPubMedGoogle Scholar
  10. Chen HJ, Yu YH, Chen CH, Hsia TC, Tsai KD, Shih CH, Hsu WH (2009) Ultrasound in peripheral pulmonary air-fluid lesions. Chest 135:1426–1432CrossRefPubMedGoogle Scholar
  11. Chian CF, WL Su, LH Soh et al. (2004) Echogenic swirling pattern as a predictor of malignant pleural effusions in patients with malignancies. Chest 126: 129–134CrossRefPubMedGoogle Scholar
  12. Colice GL, Cutis A, Deslauriers J et al. (2000) Medical and surgical treatment of parapneumonic effusions, an evidence-based guideline. Chest 18:1158–1171CrossRefGoogle Scholar
  13. Collins JD, Burwell D, Furmanski S et al. (1972) Minimal detectable pleural effusions. Radiology 105: 51–53Google Scholar
  14. Diacon AH, Brutsche MH, Solèr M (2003) Accuracy of pleural puncture sites. A prospective comparison of clinical examination with ultrasound. Chest 123: 436–441CrossRefPubMedGoogle Scholar
  15. Dorffner R, Eibenberger K, Youssefzadeh S et al. (1998) The value of sonography in the intensive care unit for the diagnosis of diaphragmatic paralysis. RöFo 169:274–277PubMedGoogle Scholar
  16. Duncan DR, Morgenthaler TI, Ryu JH, Daniels CE (2009) Reducing iatrogenic risk in thoracocentesis. Chest 135:1315–1320CrossRefPubMedGoogle Scholar
  17. Eibenberger KL, Dock WI, Ammann ME et al. (1994) Quantification of pleural effusion: Sonography versus radiography. Radiology 191: 681–684PubMedGoogle Scholar
  18. Epelman M, Navarro OM, Daneman A, Miller SF(2005) M-mode sonography of diaphragmatic motion: description of technique and experience in 278 pediatric patients, Pediatr Radiol 35:661–667CrossRefPubMedGoogle Scholar
  19. Gaba DM, Dunn WF (2009) Procedural risks in thoracocentesis. Chest 135:1120–1123CrossRefPubMedGoogle Scholar
  20. Gehmacher O, Kopf A, Scheier M et al. (1997) Ist eine Pleuritis sonographisch darstellbar? Ultraschall Med 18: 214–219CrossRefPubMedGoogle Scholar
  21. Geiger D, Düll T, von Pawel J et al. (2003) Thoraxwandinfiltration und Stichkanalinvasion beim malignen Pleuramesotheliom. Ultraschall Med 24: 34 abstractCrossRefGoogle Scholar
  22. Goecke W, Schwerk WB (1990) Die Real-Time-Sonographie in der Diagnostik von Pleuraergüssen. In: Gebhardt J, Hackelöer BJ, Klinggräff G v., Seitz K (Hrsg) Ultraschalldiagnostik’ 89. Springer, Berlin Heidelberg New York TokioGoogle Scholar
  23. Görg C, Bert T, Görg K (2005) Contrast-enhanced sonography for differential diagnosis of pleurisy and focal pleural lesions of unknown cause. Chest 128:3894–3899CrossRefPubMedGoogle Scholar
  24. Gryminski J, Krakówka P, Lypacewicz G (1976) The diagnosis of pleural effusion by ultrasonic and radiologic techniques. Chest 70: 33–37CrossRefPubMedGoogle Scholar
  25. Hansen M, Muhl E (1997) Blunt thoracic trauma — therapeutic relevance of results of roentgen image, ultrasound and computerized tomography, Langenbecks Arch Chir Suppl Kongressbd. 114:458–460PubMedGoogle Scholar
  26. Heilo A, Stenwig AE, Solheim P (1999) Malignant pleural mesothelioma: US-guided histologic core-needle biopsy. Radiology 211: 657–659PubMedGoogle Scholar
  27. Herth F, Schmitteckert H, Schulz M, Becker H (2003a) Diagnostik des Pneumothorax mittels transthorakalem Ultraschall — eine prospektive Untersuchung. Ultraschall Med 24 [Suppl 1]: S30, abstractGoogle Scholar
  28. Herth F, Schulz M, Schmitteckert H, Becker H (2003b) Vergleich transthorakaler Ultraschall (TTUS) mit Computertomographie (CT) zur Beurteilung der Tumorinvasion in die Brustwand beim Bronchialkarzinom. Ultraschall Med 24 [Suppl 1] S33, abstractGoogle Scholar
  29. Ikegami T, Ezaki T, Ishida T et al. (2004) Neurilemmoma of the diaphragm mimicking a liver tumor: case report, Abdom Imaging 29:85–86CrossRefPubMedGoogle Scholar
  30. Joyner CR Jr, Herman RJ, Reid JM (1967) Reflected ultrasound in the detection and localization of pleural effusion. JAMA 200/5: (129–132) 399–402CrossRefGoogle Scholar
  31. Katikireddy CK, Dube DS (2005) A trial of intrapleural streptokinase. NEJM 352: 2243CrossRefPubMedGoogle Scholar
  32. Kelbel C, Börner N, Schadmand S et al. (1990) Diagnostik von Pleuraergüssen bei intensivpflichtigen Patienten: Sonographie und Radiologie im Vergleich. In: Gebhardt J, Hackelöer BJ, Klinggräff G v., Seitz K (Hrsg) Ultraschalldiagnostik’ 89. Springer, Berlin Heidelberg New York TokioGoogle Scholar
  33. Kocijancic I, Kocijancic K, Cufer T (2004) Imaging of pleural fluid in healthy individuals. Clin Radiol 59: 826–829CrossRefPubMedGoogle Scholar
  34. Kocijancic I, Pusenjak S, Kocijancic K, Vidmar G (2005) Sonographic detection of physiologic pleural fluid in normal pregnant women. J Clin Ultrasound 33: 63–66CrossRefPubMedGoogle Scholar
  35. Kohzaki S, Tsurusaki K, Uetani M et al. (2003) The aurora sign: an ultrasonographic sign suggesting parenchymal lung disease. Br J Radiol 76: 437–443CrossRefPubMedGoogle Scholar
  36. Layer G, Schmitteckert H, Steudel A et al. (1999) MRT, CT und Sonographie in der präoperativen Beurteilung der Primärtumorausdehnung beim malignen Pleuramesotheliom. Fortschr Roentgenstr 170: 365–370Google Scholar
  37. Leo F, Dellamonica J, Venissac N et al. (2005) Can chest ultrasonography assess pleurodesis after VATS for spontaneous pneumothorax? Eur J Cardiothorac Surg 28: 47–49CrossRefPubMedGoogle Scholar
  38. Lichtenstein D, Goldstein I, Mourgeon E et al. (2004) Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology 100:1–2CrossRefGoogle Scholar
  39. Lichtenstein D, Mezière G, Bidermann P (1997) The comet tail artifact: an ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med 156:1640–1646PubMedGoogle Scholar
  40. Lichtenstein D, Meziere G, Bidermann P, Gepner A (2000) The “lung point”: an ultrasound sign specific to pneumothorax. Intensive Care Med 26:1434–1440CrossRefPubMedGoogle Scholar
  41. Lichtenstein DA, Meziére GA (2008) Relevance of lung ultrasound in the diagnosis of acute respiratory failure. The BLUE-protocol. Chest 134:117–125CrossRefPubMedGoogle Scholar
  42. Lichtenstein DA, Menu Y (1995) A bedside ultrasound sign ruling out pneumothorax in the critically ill: lung sliding. Chest 108:345–348CrossRefGoogle Scholar
  43. Lieber A, Pons F, Düsel W et al. (2006) Hat die Thorakoskopie beim Thoraxtrauma einen Platz? Chirurg 77:1014–1021CrossRefPubMedGoogle Scholar
  44. Lloyd T, Tang YM, Benson MD, King S (2006) Diaphragmatic paralysis: the use of M-mode ultrasound for diagnosis in adults. Spinal Cord 44:505–508CrossRefPubMedGoogle Scholar
  45. Loddenkemper R (1994) Pleuraerkrankungen. In: Ferlinz R (Hrsg) Pneumologie in Praxis und Klinik. Thieme, Stuttgart, S 712–717Google Scholar
  46. Lorenz J, Börner N, Nikolaus HP (1988) Sonographische Volumetrie von Pleuraergüssen. Ultraschall 9: 212–215CrossRefGoogle Scholar
  47. Maskell NA, Butland RJA (2003) BTS guidelines for the investigation of a unilateral pleural effusion in adults. Thorax 58: ii8Google Scholar
  48. Maskell NA, Davies CWH, Nunn AJ et al. (2005) U.K. controlled trial of intrapleural streptokinase for pleural infection (MIST1). NEJM 352: 865–874CrossRefPubMedGoogle Scholar
  49. Mayo PH, Beaulieu Y, Doelken P et al. (2009) American College of chest physicians/La société de reanimation de langue francaise, Statement on competence in critical care ultrasonography. Chest 135:1050–1060CrossRefPubMedGoogle Scholar
  50. Mowé G, Tellnes G (1995) Malignant pleural mesothelioma in Norway 1960–1992. Tidsskr Nor Laegeforen 115: 706–709PubMedGoogle Scholar
  51. Nakano N, Yasumitsu T, Kotake Y et al. (1994) Preoperativ histologic diagnosis of chest wall invasion by lung cancer using ultrasonically guided biopsy. J Thoracic Cardiovasc Surg 107: 891–895Google Scholar
  52. Noble VE, Murray AF, Capp R, Sylvia-Reardon MH, Steele DJR, Liteplo A (2009) Ultrasound assessment for extravascular lung water in patients undergoing hemodialysis. Time course for resolution. Chest 135:1433–1439CrossRefPubMedGoogle Scholar
  53. Reissig A, Kroegel C (2005) Accuracy of transthoracic sonography in excluding postinterventional pneumothorax and hydropneumothorax. Comparison to chest radiography. Eur J Radiol 53: 463–470PubMedGoogle Scholar
  54. Reuß J (1996) Sonographic imaging of the pleura: nearly 30 years experience. Europ J Ultrasound 3: 125–139CrossRefGoogle Scholar
  55. Reuß J, Blank W, Drews U et al. (2002) Sonographisch-anatomischer Vergleich des Aufbaus der inneren Thoraxwand zwischen Interkostalmuskulatur und Pleuraspalt. Ultraschall Med 23 [Suppl 1]: S70, abstractGoogle Scholar
  56. Roch A, Bojan M, Michelet P et al. (2005) Usefulness of ultrasonography in predicting pleural effusions >500mL in patients receiving mechanical ventilation. Chest 127:224–232CrossRefPubMedGoogle Scholar
  57. Rubikas R (2001) Diaphragmatic injuries Eur J Cardiothorac Surg 20:53–57CrossRefPubMedGoogle Scholar
  58. Saito T, Kobayashi H, Kitamura S (1988) Ultrasonic appraoch to diagnosing chest wall tumors. Chest 94: 1271–1275CrossRefPubMedGoogle Scholar
  59. Shiotani S, Sugimura K, Sugihara M et al. (2000) Detection of minute pleural fluid in the pleural retracted space associated with peripheral lung cancer: evaluation with MR imaging. Radiat Med 18: 21–27PubMedGoogle Scholar
  60. Soldati G, Testa A, Sher S, Pignataro G, La Sala M, Silveri NG (2008) Occult traumatic pneumothorax — diagnostic accuracy of lung ultrasonography in the emergency department. Chest 133:204–211CrossRefPubMedGoogle Scholar
  61. Soldati G, Testa A, Silva FR, Carbone L, Portale G, Silveri NG (2006) Chest ultrasonography in lung contusion, Chest 130:533–538CrossRefPubMedGoogle Scholar
  62. Stark DD, Federle MP, Goodman PC, Podrsky AE, Webb WR (1983) Differentiating lung abscess and empyema: radiography and computed tomography. AJR 141: 163–167PubMedGoogle Scholar
  63. Sugarbaker DJ, Jaklitsch MT, Liptay MJ (1995) Mesothelioma and radical multimodality therapy: who benefits? Chest 107: 345–350CrossRefGoogle Scholar
  64. Suzuki N, Saitoh T, Kitamura S (1993) Tumor invasion of the chest wall in lung cancer: diagnosis with US. Radiology 187: 39–42PubMedGoogle Scholar
  65. Urvoas E, Pariente D, Fausser C et al. (1994) Diaphragmatic paralysis in children: diagnosis by TM-mode ultrasound. Pediatr Radiol 24:564–568CrossRefPubMedGoogle Scholar
  66. Vermillion J, Wilson E, Smith R (2001) Traumatic diaphragmatic hernia presenting as a tension fecopneumothorax. Hernia 5:158–160CrossRefPubMedGoogle Scholar
  67. Vignon P, Chastagner C, Berkane V et al. (2005) Quantitative assessment of pleural effusion in critically ill patients by means of ultrasonography. Crit Care Med 33:1757–1763CrossRefPubMedGoogle Scholar
  68. Volpicelli G, Caramello V, Cardinale L, Cravino M (2008) Diagnosis of radio-occult pulmonary conditions by real-time chest ultrasonography in patients with pleuritic pain. Ultrasound Med Biol 34:1717–1723CrossRefPubMedGoogle Scholar
  69. Volpicelli G, Mussa A, Garofalo G et al. (2006) Bedside lung ultrasound in the assessment of alveolar-interstitieal syndrome. Am J Emerg Med 24:689–696CrossRefPubMedGoogle Scholar
  70. Wahidi MM, Herth FJF, Ernst A (2007) State of the art — interventional pulmonology. Chest 131:261–274CrossRefPubMedGoogle Scholar
  71. Wernecke K (2000) Ultrasound study of the pleura. Eur Radiol 10: 1515–1523CrossRefPubMedGoogle Scholar
  72. Wirbel RJ, Mutschler W (1998) Blunt rupture of the right hemidiaphragm with complete dislocation of the right hepatic lobe: report of a case. Surg Today 28:850–852CrossRefPubMedGoogle Scholar
  73. Wu RG, Yuan A, Liauw YS et al. (1994) Image comparison of real-time gray-scale ultrasound and color Doppler ultrasound for use in diagnosis of minimal pleural effusion. Am J Respir Crit Care Med 150: 510–514PubMedGoogle Scholar
  74. Yang PC, Luh KT, Chang DB, Wu HD, Yu CJ, Kuo SH (1992) Value of sonography in determining the nature of pleural effusion: analysis of 320 cases. AJR 159: 29–33PubMedGoogle Scholar
  75. Yu CJ, Yang PC, Chang DB, Luh KT (1992) Diagnostic and therapeutic use of chest sonography: value in critically ill patients. AJR 159: 695–701PubMedGoogle Scholar
  76. Ziegler CM, Seitz K, Leicht-Biener U, Mauch M (2004) Detection of therapeutically relevant diagnoses made by sonography of the upper abdomen: portable versus high-end-sonographic units — a prospective study. Ultraschall Med 25: 428–432CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag Berlin Heidelberg 2010

Authors and Affiliations

  1. 1.Klinikum Sindelfingen/BöblingenKliniken BöblingenBöblingenDeutschland

Personalised recommendations