Zusammenfassung
Thorakaler Schmerz zählt neben Dyspnoe und Husten zu den häufigsten Symptomen pulmonaler Erkrankungen. Die weite Differenzialdiagnose reicht von der sehr schmerzhaften, aber prognostisch gutartigen akuten Pleuritis bis zu lebensbedrohlichen Ereignissen wie Lungenembolien oder thorakalen Malignomen. Der primäre Spontanpneumothorax ist durch ein akutes Schmerzereignis gekennzeichnet. Schmerzen im Kontext einer respiratorischen Infektion, beispielsweise einer Pneumonie, bereiten kaum Schwierigkeiten in der Zuordnung. Eine erste Näherung an die Diagnose ermöglicht die anamnestische Frage nach einer Atemabhängigkeit; diese charakterisiert den pleuritischen Schmerz. Eher atemunabhängig stellen sich in der Regel Schmerzen bei der pulmonalen Hypertonie und bei thorakalen Malignomen wie dem peripheren Lungenkarzinom und dem Mesotheliom dar. Eine besondere diagnostische Herausforderung sind Thoraxschmerzen im Rahmen einer Exazerbation der chronisch-obstruktiven Lungenerkrankung. Hier muss immer nach einer möglichen kardialen Komorbidität wie dem akuten Koronarsyndrom gesucht werden.
Abstract
Chest pain represents one of the most frequent symptoms of pulmonary diseases, in addition to dyspnea and cough. The broad differential diagnostics include the intensely painful but prognostically benign acute pleurisy as well as potentially life-threatening events, such as acute pulmonary embolism or malignant chest diseases. Primary spontaneous pneumothorax is characterized by acute chest pain. Pain associated with a respiratory infection, such as pneumonia rarely poses a difficult diagnostic problem. Painful diseases of the lungs can be differentiated in an initial approach by asking the patient if the pain is related to breathing, which is characteristic of pleuritic chest diseases. Pulmonary hypertension, lung cancer and mesothelioma show more constant pain unrelated to respiratory movements. It is most important to differentiate pain associated with acute exacerbation of chronic obstructive pulmonary disease (COPD), whereby a possible cardiac comorbidity, such as acute coronary syndrome (ACS) should always be considered.
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C.F. Vogelmeier, Marburg
T. Welte, Hannover
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Jany, B. Pneumologische Ursachen für Thoraxschmerz. Internist 58, 22–28 (2017). https://doi.org/10.1007/s00108-016-0169-9
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DOI: https://doi.org/10.1007/s00108-016-0169-9