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Pleura

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Bildatlas der Lungensonographie

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Zusammenfassung

Am normalen Thorax reicht die transthorakale Sonographie höchstens bis zum Rippfell. Der knöcherne Brustkorb erschwert die Darstellung der Pleura durch den Schallschatten hinter den Rippen und dem Sternum. Eine geeignete Untersuchungstechnik ermöglicht einen Einblick in die Pleura durch die Interkostalräume, bei Abwinkelung des Schallkopfes auch in die parietale Pleura hinter den Rippen. Die klinischen Fragestellungen, die eine Ultraschalluntersuchung der Pleura indizieren, sind vielfältig: sonographisch sichtbare Veränderungen wie Pleuraerguss, Pleuritis, Pleuratumor, Pleurafibrose oder Pneumothorax, aber auch durch interstitielles Syndrom bei Herzinsuffizienz, ARDS, Pneumonie, Lungenatelektase aufgrund eines zentralen Lungentumors und Lungenembolie, eine Zwerchfellparese oder Zwercherhöhung aufgrund von Aszites. In aufrechter Position befindet sich der freischwebende Pleuraerguss in den untersten Teilen des costo-diaphragmatischen Pleurarezesses. Je nach Ätiologie des Ergusses kann sich der Inhalt unterschiedlich darstellen. Transudate bei Herzinsuffizienz, Hypoproteinämie oder Leberzirrhose sind normalerweise echofrei. Blut, Eiter oder Chylus reflektieren den Ultraschall anders, daher sind diese Ergüsse echogen. Jede Thorakozentese sollte unter sonographischer Kontrolle durchgeführt werden.

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Author information

Authors and Affiliations

  1. Böblingen, Deutschland

    Joachim Reuß

  2. Klinikum am Steinenberg, Medizinische Klinik, Internist, Reutlingen, Deutschland

    Alexander Heinzmann

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  1. Joachim Reuß
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  2. Alexander Heinzmann
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Editors and Affiliations

  1. Rankweil, Österreich

    Gebhard Mathis

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Reuß, J., Heinzmann, A. (2022). Pleura. In: Mathis, G. (eds) Bildatlas der Lungensonographie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-62409-8_3

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  • DOI: https://doi.org/10.1007/978-3-662-62409-8_3

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-62408-1

  • Online ISBN: 978-3-662-62409-8

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