Zusammenfassung
Maligne Pleuraergüsse mit ihrem Hauptsymptom Atemnot sind ein häufiges Problem bei
Patienten mit bösartigen Tumorerkrankungen. Verantwortlich führend ist der Lungenkrebs,
gefolgt vom Mammakarzinom und den malignen Lymphomen. Die Häufigkeit des Pleuramesothelioms
nimmt in den Industrieländern zu. In dieser Übersicht, die auf dem ERS/ATS-Statement
2001 basiert, werden das diagnostische Vorgehen, die Differenzialdiagnostik - einschließlich
der Ursachen paramaligner Pleuraergüsse - und die therapeutischen Möglichkeiten aufgezeigt.
Bei den lokalen Maßnahmen steht die Pleurodese im Vordergrund, heute vorzugsweise
mittels thorakoskopischer Talkum-Puderung. Alternative lokale und systemische Behandlungsmöglichkeiten
werden eingehend besprochen. Speziell wird auf die Epidemiologie, Diagnostik, Therapie
und Prognose beim Lungenkarzinom, beim Mammakarzinom und bei den malignen Lymphomen
eingegangen. Abschließend werden offene Fragen aufgezählt, die der zukünftigen Forschung
bedürfen und hoffentlich die Therapie und Prognose der malignen Ergüsse verbessern
werden.
Abstract
Malignant pleural effusions with dyspnoea as their most common presenting symptom
are a frequent clinical problem in patients with neoplastic disease. Lung carcinoma
is the leading cause, followed by breast carcinoma and malignant lymphoma. The frequency
of malignant mesothelioma is increasing in industrialized countries. In this overview,
which is based on the ERS/ATS Statement 2001, the diagnostic approach, the differential
diagnosis including causes of paramalignant effusions, as well as the therapeutic
possibilities are described. Pleurodesis is the most important therapeutic modality,
today preferably via thoracoscopic talc poudrage. Alternative local and systemic treatment
options are discussed in detail. A special emphasis is put on the epidemiology, diagnosis,
treatment, and prognosis of malignant effusions in patients with lung and breast carcinomas,
and with lymphomas. Finally, open questions are listed which need future research,
which will hopefully improve the treatment and prognosis of malignant pleural effusions.
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Bereits publizierte Beiträge zu dieser Serie:
- 108
Bildgebende Diagnostik bei Pleuraerkrankungen.
Pneumologie.
2004;
58
238-254
- 709
Pleura: Pathologie nicht-neoplastischer Erkrankungen.
Pneumologie.
2004;
58
516-524
- 110
Pleuramesotheliom - Pathologie und Pathogenese.
Pneumologie.
2004;
58
670-679
- 111
Diagnostisches Vorgehen beim Pleuraerguss.
Pneumologie.
2004;
58
777-790
Prof. Dr. med. R. Loddenkemper
HELIOS Klinikum Emil von Behring · Lungenklinik Heckeshorn · Zentrum für Pneumologie
und Thoraxchirugie
Zum Heckeshorn 33
14109 Berlin
Email: loddheck@zedat.fu-berlin.de
