Bildgebung zur Klärung des Behandlungsfehlervorwurfs

ZusammenfassungBei der Begutachtung von Behandlungsfehlervorwürfen können Methoden der Bildgebung je nach Fragestellung der Dokumentation entscheidender morphologischer Befunde für oder gegen den Verdacht einer iatrogen verursachten Schädigung dienen. Die Klärung von Todesfällen kann in diesem Zusammenhang durch postmortale Bildgebung (v. a. native Computertomographie, Angiographie, Magnetresonanztomographie) sinnvoll unterstützt werden. Die Bildgebung bietet gegenüber der Obduktion einen entscheidenden Mehrwert beim Nachweis von iatrogener Luftembolie. Sie ist ferner zur Dokumentation von Fehllagen eingebrachter medizinischer Hilfsmittel geeignet, wenn sie vor der Leicheneröffnung im Rahmen der Autopsie durchgeführt wird, da diese mit der Gefahr der Verlagerung einhergeht. Ergänzende Informationen lassen sich bei der Suche nach Blutungsquellen und der Dokumentation von Perfusionsverhältnissen nach kardiovaskulären Eingriffen gewinnen. Entscheidende Kriterien für die Indikationsstellung einer postmortalen Bildgebung werden aus der notwendigen vorausgehenden Einsichtnahme in klinische Dokumentationen gewonnen.AbstractIn the assessment of medical malpractice imaging methods can be used for the documentation of crucial morphological findings which are indicative for or against an iatrogenically caused injury. The clarification of deaths in this context can be usefully supported by postmortem imaging (primarily native computed tomography, angiography, magnetic resonance imaging). Postmortem imaging offers significant additional information compared to an autopsy in the detection of iatrogenic air embolisms and documentation of misplaced medical aids before dissection with an inherent danger of relocation. Additional information is supplied by postmortem imaging in the search for sources of bleeding as well as the documentation of perfusion after cardiovascular surgery. Key criteria for the decision to perform postmortem imaging can be obtained from the necessary preliminary inspection of clinical documentation.

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