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Diagnostik der venösen Thrombose und Lungenembolie

Diagnostics in venous thrombosis and pulmonary embolism

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Zusammenfassung

Beinvenenthrombosen und Lungenembolien (venöse Thromboembolie) sind mit einer jährlichen Inzidenz von 1–2/1000 Einwohner häufige Erkrankungen. Ihre akut lebensbedrohlichen wie ihre behindernden Langzeitfolgen können durch rechtzeitige Diagnostik und Therapie wirksam vermieden oder vermindert werden. Wegen der vielgestaltigen klinischen Erscheinungsformen ist es notwendig, den Verdacht auf eine venöse Thromboembolie häufig zu stellen. Auf diese Weise hat nur einer in 5–6 Verdachtsfällen tatsächlich die Erkrankung. Eine als niedrig eingeschätzte klinische Wahrscheinlichkeit in Verbindung mit einem negativen D-Dimer-Test kann 40–50% der Verdachtsfälle sicher als negativ einstufen. Die anderen Patienten müssen mit bildgebenden Methoden untersucht werden. Für die Beinvenenthrombose ist dazu heute der venöse Ultraschall die Methode der Wahl, für die Lungenembolie die CT-Pulmonalisangiographie. Sensitivität und Spezifität beider Untersuchungsmethoden sind hoch genug, um eine definitive Diagnose zu stellen. Problemfälle der Diagnostik bleiben der Verdacht auf rezidivierende thromboembolische Ereignisse sowie die venöse Thromboembolie in der Schwangerschaft.

Abstract

Deep vein thrombosis and pulmonary embolism (venous thromboembolism) have a prevalence as high as 1–2/1000/year. Timely diagnosis and therapy prevent or reduce the acute life threatening and the long term disabling complications. Due to the variability in its signs and symptoms, venous thromboembolism should frequently be considered as a differential diagnosis. When doing so, only one in five or six suspected cases actually will have the disease. A low estimate of the clinical probability in conjunction with a negative D-Dimer test may rule out the diagnosis in 40–50% of cases. All other patients need imaging procedures. Current standard of care for deep vein thrombosis is venous ultrasound of the leg, for pulmonary embolism it is CT pulmonary angiography. Sensitivity and specificity of both methods are high enough to allow for a definitive diagnosis. Diagnostic challenges remain the suspicion of relapsing disease and venous thromboembolism in pregnancy.

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  1. Medizinische Klinik 2, Krankenhaus Dresden-Friedrichstadt, Friedrichstraße 41, 01067, Dresden, Deutschland

    S.M. Schellong

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Schellong, S. Diagnostik der venösen Thrombose und Lungenembolie. Internist 51, 325–334 (2010). https://doi.org/10.1007/s00108-009-2513-9

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