Differenzialdiagnostik der diffusen alveolären Hämorrhagie

Zusammenfassung

Eine diffuse alveoläre Hämorrhagie bezeichnet eine diffuse intraalveoläre Blutung aus kleinen Blutgefäßen infolge einer schweren Schädigung der alveolokapillären Membran der Lungen. Dies ist ein relativ seltenes, dann jedoch oft lebensbedrohliches Ereignis. Das differenzialdiagnostische Spektrum ist vielfältig und beinhaltet sowohl immunologische, als auch toxische, infektiöse, hämodynamische, neoplastische und physikalische Ursachen. Bei einer diffusen alveolären Hämorrhagie kann es sich um eine Folge sowohl von Systemerkrankungen, als auch von auf die Lunge beschränkten Prozessen handeln. Die häufigsten Ursachen sind die sogen. Kleingefäßvaskulitiden, die mikroskopische Polyangiitis und die Wegener'sche Granulomatose. Seltenere Ursachen sind das Goodpasture-Syndrom und der systemische Lupus erythematodes. Neben autoimmunen Prozessen müssen vor allem Erkrankungen mit eine Steigerung der linksventrikulären Vorlast, Infektionen und Medikamentennebenwirkungen in Betracht gezogen werden. Es wird ein Überblick über das differenzialdiagnostische Spektrum und das diagnostische Vorgehen bei diesen Patienten gegeben. Da eine frühzeitige aggressive Behandlung lebensrettend sein kann, ist eine rasche und gezielte Diagnostik entscheidend.

Abstract

Diffuse alveolar haemorrhage (DAH) denotes a diffuse intra-alveolar bleeding from small vessels as a result of severe damage of the alveolocapillary membrane of the lungs. These are comparatively rare, but than often life threatening events. The differential diagnosis is broad and comprises immunologic as well as toxic, infectious, hemodynamic, neoplastic and physical causes. DAH may be a manifestation of systemic diseases, as well as a result of an injury restricted to the lungs. The most frequent systemic diseases, that cause DAH are the so-called small vessel vasculititis-microscopic polyangiitis and Wegener's granulomatosis. More rarely Goodpasture's syndrome and systemic lupus erythematosus are causal. Alongside the immunologic processes mainly diseases with increased left-ventricular preload, infections and side effects of drugs have to be kept in mind. This review summarizes the differential diagnostic spectrum and the diagnostic workup of patients with DAH. Because early aggressive treatment can be life-saving, early and aimed diagnostics is essential.

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