Endobronchialer Ultraschall zur Diagnostik im Mediastinum

Abstract

The development of endobronchial ultrasound (EBUS) is one of the most important advances in bronchoscopy in recent years. Two different techniques are available which improve sonographic diagnostics of the mediastinum and staging in patients with lung and non-lung cancer. Radial EBUS and the technique of ultrasound-controlled transbronchial needle aspiration (TBNA) are now routine practice in many pulmonary centers. Their clinical application and diagnostic benefit have been established in many studies comparing them with conventional radiologic methods and other diagnostic procedures. Endobronchial ultrasound as a diagnostic tool is expected to gain importance in the near future. Especially the method combining EBUS and TBNA may replace more invasive methods such as mediastinoscopy for evaluating patients with unknown mediastinal lesions or for staging patients with lung cancer.

Endobronchial Ultrasound Today

“…In such patients, the application of EBUS under general anesthesia has been recommended as apnea may occur for 4 minutes. 6 …”

“…As water is an excellent conductor of sound waves, the use of a balloon optimized the contact between the probe and the bronchial wall, thereby improving the visualization of the bronchial wall structure and the surrounding structures. 3,5,6 However, as a balloon could obstruct the tracheobronchial tree, great care had to be taken to prevent it from inflating in the trachea or the main bronchus of pneumonectomized patients. In such patients, the application of EBUS under general anesthesia has been recommended as apnea may occur for 4 minutes.…”

Anesthesia for Bronchoscopy

“…This combination allows the operator to perform directed needle aspiration of abnormal mediastinal structures instead of "blind" transbronchial needle aspirations. It is an accurate, safe and cost-effective technique that facilitates the biopsy of mediastinal lymph nodes and peribronchial lesions [21,22].…”

Endoskopische Evaluation des Mediastinums

“…Darüber hinaus können auch Gefäß-anomalien, entzündliche Atemwegserkrankungen sowie Zysten einer sonomorphologischen und zytologischen Diagnostik zugeführt werden [28]. Durch den EBUS können die hilären (LK 10/11) Lymphknoten beidseitig sowie je nach Anatomie die lobaren Stationen 12 und 13 und die mediastinalen Stationen 2 und 4 beidseitig, 3 und 7 untersucht werden.…”

“…Die Ankopplung an die Bronchialschleimhaut kann durch den Einsatz eines Ballons an der Endoskopspitze verbessert werden. Durch einen Power-Doppler-Modus können farblich solide Strukturen von zentralen Gefäßen unterschieden werden [28].…”