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Der akute Thoraxschmerz, ein rein klinisches Problem oder radiologische Fragestellung?

Acute chest pain: a purely clinical problem or a question for radiology?

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Zusammenfassung

Der akute Thoraxschmerz repräsentiert ein sehr häufiges klinisches Beschwerdebild und gleichzeitig ein großes diagnostisches Dilemma, können sich doch sowohl lebensbedrohliche akute Ereignisse (wie der akute Herzinfarkt) als auch mehr oder weniger harmlose Schmerzzustände und Erkrankungen (wie vertebrogene Schmerzen) unter dem Leitsymptom „akuter Thoraxschmerz“ präsentieren. Diese oft nicht eindeutige Symptomatik, hinter der immer auch ein lebensbedrohliches Krankheitsbild stecken kann, führt zu einer Übertriagierung der Patienten in Notaufnahmen und zu einer großen Anzahl an stationären „Absicherungsaufnahmen“. Besonders die Diagnose eines akuten Koronarsyndroms (AKS) bei initial fehlenden ischämietypischen EKG-Veränderungen stellt eine spezielle Problematik dar. Durch die Verfügbarkeit moderner ultraschneller Multidetektorcomputertomographen (MDCT) spielt der Radiologe in der Diagnostik und Abklärung des akuten Thoraxschmerzes eine zunehmend wichtige Rolle. Im Folgenden sollen die klinischen Schwierigkeiten und radiologischen Möglichkeiten der Diagnose von Patienten mit akutem Thoraxschmerz vorgestellt und mögliche zukünftige Diagnosealgorithmen diskutiert werden.

Abstract

Acute chest pain represents a very common clinical occurrence and at the same time poses a severe diagnostic dilemma. It can be due to an acute life-threatening event such as acute cardiac infarct, or a relatively harmless condition of pain and illness (e.g. vertebrogenic pain) under the main symptom category of acute chest pain. This often unclear symptomatic, behind which there can always be a life-threatening disease leads to an exaggerated grouping of patients into emergency cases and to an increased number of inpatients for observation. The diagnosis of acute coronary syndrome with no initial ECG changes typical for ischemia is especially problematic. The availability of modern multidetector computed tomography is becoming increasingly more important for radiologists in the diagnosis and clarification of acute chest pain. In this article the clinical difficulties and radiology options for the diagnosis of patients with acute chest pain will be presented and possible future algorithms for diagnosis will be discussed.

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  1. Klinische Abteilung für Kardiovaskuläre und Interventionelle Radiologie, Universitätsklinik für Radiodiagnostik, Medizinische Universität Wien, Währinger Gürtel 18–20, A-1090, Wien, Österreich

    C. Loewe

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Loewe, C. Der akute Thoraxschmerz, ein rein klinisches Problem oder radiologische Fragestellung?. Radiologe 48, 448–456 (2008). https://doi.org/10.1007/s00117-008-1656-3

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