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Ley S, Biederer J, Ley-Zaporozhan J, Wielpütz MO, Vogel-Claussen J, Das M, Hamer O. [Chest X-ray: implementation and indication : Recommendations of the thoracic imaging working group of the German Radiological Society]. Radiologe 2022; 62:149-157. [PMID: 35006315 DOI: 10.1007/s00117-021-00952-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Even after more than 100 years, the chest X‑ray is still an important technique to detect important pathological changes of lungs, heart and vessels in a fast and low-dose manner. For the German-speaking regions, there are only recommendations available published by the "Ständigen Strahlenschutzkommission (SSK)" regarding the indication. These recommendations are not updated on a regular basis and more recent developments are only integrated with delayed. METHODS The chest division of the German Radiological Society has summarized their expertise for the usage and indication of the chest X‑ray. Especially within the field of oncology the usage of chest X‑ray is evaluated differently to the aforementioned recommendations; here chest computed tomography (CT) is much more sensitive for evaluation of metastasis and local invasion of tumors. Also, within the area of infectious diseases in non-immunocompetent patients, CT is the method of choice. Based on the structure of the current recommendations, many current guidelines and indications are summarized and presented within the context of the usage of chest X‑ray.
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Affiliation(s)
- Sebastian Ley
- Diagnostische und Interventionelle Radiologie, Artemed Klinikum München Süd, Am Isarkanal 30, 81379, München, Deutschland. .,Radiologie, Internistisches Klinikum München Süd, Am Isarkanal 36, München, Deutschland.
| | - Jürgen Biederer
- Diagnostische und interventionelle Radiologie, Universitätsklinikum Heidelberg, 69120, Heidelberg, Deutschland.,Translational Lung Research Centre Heidelberg (TLRC), Mitglied des Deutschen Zentrums für Lungenforschung (DZL), 69120, Heidelberg, Deutschland.,Faculty of Medicine, University of Latvia, Raina bulvaris 19, 1586, Riga, Lettland.,Medizinische Fakultät, Christian-Albrechts-Universität zu Kiel, 24098, Kiel, Deutschland
| | - Julia Ley-Zaporozhan
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, LMU München, München, Deutschland.,Comprehensive Pneumology Center Munich (CPC-M), Deutsches Zentrum für Lungenforschung (DZL), München, Deutschland
| | - Mark O Wielpütz
- Translational Lung Research Centre Heidelberg (TLRC), Mitglied des Deutschen Zentrums für Lungenforschung (DZL), 69120, Heidelberg, Deutschland.,Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland.,Klinik für Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Thoraxklinik, Universitätsklinikum Heidelberg, Röntgenstr. 1, 69126, Heidelberg, Deutschland
| | - Jens Vogel-Claussen
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, Hannover, Deutschland.,2 BREATH (Biomedical Research in End-stage and Obstructive Lung Disease Hannover), Deutsches Zentrum für Lungenforschung (DZL), Hannover, Deutschland
| | - Marco Das
- Klinik für diagnostische und interventionelle Radiologie, Helios Klinikum Duisburg, Duisburg, Deutschland
| | - Okka Hamer
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Deutschland.,Abteilung für Radiologie, Klinik Donaustauf, Donaustauf, Deutschland
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Abstract
ZUSAMMENFASSUNGRasches Handeln ist gefragt, wenn der Verdacht auf eine Infektion bei einem immunsupprimierten Patienten besteht. Wenn es sich nicht gerade um einen tropischen Keim von der Kreuzfahrt bzw. den multiresistenten Keim von einem der letzten Klinikaufenthalte handelt – der Erreger ist meist nicht das Problem! Es ist seine Präsentation, die Ausprägung seiner klinischen Manifestation und seine Reaktion auf die Therapie, die für uns zur Herausforderung wird. Ist stets die Veränderung der Immunreaktion durch immer selektiver wirksame Biologika das Thema? Oder müssen wir uns erst mit den Reaktionen des innaten und adaptiven Immunsystems vertraut machen, um zu verstehen, was wir sehen?
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Moeser A, Lerche M, Wirtz H, Stallmach A. [Aspects of pulmonary involvement in inflammatory bowel disease]. Internist (Berl) 2018; 59:876-885. [PMID: 30116854 DOI: 10.1007/s00108-018-0473-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The incidence of pulmonary manifestations of inflammatory bowel disease (IBD) appears to be much higher than previously assumed. In prospective studies, subclinical pulmonary interstitial infiltrates or pathological lung function were found in 40%-60% of IBD patients, both in children and adults. Pulmonary disorders can affect any part of the respiratory system, the most frequent pattern being inflammation of the large airways often associated with bronchiectasis. The differential diagnosis should include drug-related pulmonary disease and infectious causes when receiving immunosuppressive therapy. The diagnostic approach consists of a thorough history and clinical status as well as lung function tests including body plethysmography and high-resolution computed tomography of the thorax. Bronchoscopy with broncheoalveolar lavage and sample collection for histology as well as exclusion of pulmonary embolism may be indicated. Pulmonary disease in association with IBD can develop at any time during the course of IBD: in rare cases, symptoms can evolve even before gastrointestinal symptoms appear. On the other hand, there are frequent reports on the occurrence of pulmonary inflammation after proctocolectomy in patients with ulcerative colitis. The pathophysiologic background is largely unknown, but there seems to be an interaction between gastrointestinal and pulmonary inflammation. The mainstay of therapy are inhaled or systemic corticosteroids. Most patterns of pulmonary involvement in IBD respond well to corticosteroid therapy. Rarely, serious and persisting complications occur, such as strictures or stenosis of the large airways.
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Affiliation(s)
- A Moeser
- Institut für Infektionsmedizin und Krankenhaushygiene, Klinik für Innere Medizin/FB Pneumologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
| | - M Lerche
- Abteilung für Pneumologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - H Wirtz
- Abteilung für Pneumologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - A Stallmach
- Klinik für Innere Medizin IV, Universitätsklinikum Jena, Am Klinikum 1, Jena, Deutschland
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Moeser A, Lange C, von Lilienfeld-Toal M, Welte T, Pletz M. [Pneumonia in immunocompromised patients]. DER PNEUMOLOGE 2018; 15:209-224. [PMID: 32214959 PMCID: PMC7088144 DOI: 10.1007/s10405-018-0174-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Pneumonia occurs frequently in immunocompromised patients and often shows a complicated course of disease when compared to immunocompetent persons. The type of pathogen involved is directly associated with the type of immunosuppression and includes a wide variety of pathogens. Congenital and primary immunodeficiencies often appear during childhood. Acquired immunodeficiencies are most commonly caused by immunosuppressive medication. The concept of immunosuppression can be extended to patients with COPD or elderly patients because the variety of pathogens and specific features regarding frequency and course of the disease are similar to immunosuppressed patients. Computed tomography can provide an indication of the pathogen and is superior to the chest x‑ray in this respect. Blood cultures, antigen and PCR tests are non-invasive diagnostic tools for pathogen diagnostics. Invasive tests include fiberoptic bronchoscopy and complete the diagnostic methods of identifying the causative pathogen.
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Affiliation(s)
- A. Moeser
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Am Klinikum 1, 07747 Jena, Deutschland
| | - C. Lange
- Medizinische Klinik, Forschungszentrum Borstel, Leibniz Lungenzentrum, Borstel, Deutschland
| | - M. von Lilienfeld-Toal
- Klinik für Innere Medizin II (Hämatologie und Onkologie), Universitätsklinikum Jena, Jena, Deutschland
| | - T. Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - M. Pletz
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Am Klinikum 1, 07747 Jena, Deutschland
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Dalhoff K, Ewig S, Abele-Horn M, Andreas S, Bauer TT, von Baum H, Deja M, Gastmeier P, Gatermann S, Gerlach H, Grabein B, Höffken G, Kern W, Kramme E, Lange C, Lorenz J, Mayer K, Nachtigall I, Pletz M, Rohde G, Rosseau S, Schaaf B, Schaumann R, Schreiter D, Schütte H, Seifert H, Sitter H, Spies C, Welte T. Adult patients with nosocomial pneumonia: epidemiology, diagnosis, and treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:634-40. [PMID: 24133545 DOI: 10.3238/arztebl.2013.0634] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 06/13/2013] [Indexed: 01/26/2023]
Abstract
BACKGROUND Nosocomial pneumonia is among the most common types of infection in hospitalized patients. The increasing prevalence of multi-drug resistant organisms (MDROs) in recent years points to the need for an up-to-date clinical guideline. METHODS An interdisciplinary S3 guideline was created on the basis of a systematic literature review in the PubMed and Cochrane Library databases, with assessment and grading of the evidence according to the GRADE system. RESULTS 9097 abstracts and 808 articles were screened in full text, and 22 recommendations were issued. It is recommended that any antimicrobial treatment should be preceded by a microbiological diagnostic evaluation with cultures of blood and respiratory samples. The diagnosis of nosocomial pneumonia should be suspected in any patient with a new or worsened pulmonary infiltrate who meets any two of the following three criteria: leucocyte count above 10,000 or below 4000/µL, temperature above 38.3°C, and/or the presence of purulent respiratory secretions. The initially calculated antimicrobial treatment should be begun without delay; it should be oriented to the locally prevailing resistance pattern, and its intensity should be a function of the risk of infection with MDROs. The initial treatment should be combination therapy if there is a high risk of MDRO infection and/or if the patient is in septic shock. In the new guideline, emphasis is laid on a strict de-escalation concept. In particular, antimicrobial treatment usually should not be continued for longer than eight days. CONCLUSION The new guideline's recommendations are intended to encourage rational use of antibiotics, so that antimicrobial treatment will be highly effective while the unnecessary selection of multi-drug-resistant organisms will be avoided.
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Affiliation(s)
- Klaus Dalhoff
- Department of Pulmonology, University Medical Center Schleswig-Holstein, Campus Lübeck
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Länger F, Kreipe HH. [Immunodeficiency and immunocompromised patients. Opportunistic infection of the lungs]. DER PATHOLOGE 2011; 32:411-7. [PMID: 21935762 DOI: 10.1007/s00292-011-1497-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The number of patients suffering from innate, acquired or iatrogenic immunodeficiency is constantly rising. Thus the number of clinically relevant infections caused by rare or unusual pathogens is also increasing. Histopathological investigations allow the identification of difficult to culture infectious agents as well as the differentiation of tissue invasive infections from superficial colonization. In this review morphological reaction patterns and their differential diagnoses of the most common bacterial, viral and mycotic infections in the lungs of immunocompromised patients are discussed.
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Affiliation(s)
- F Länger
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
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