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Lung abscess

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Lung abscess

Lung abscess

Acute pulmonary suppurations (lung abscess, gangrenous abscess, lung gangrene) belong to the most severe pathology. Despite numerous publications on this issue, it is impossible to get a clear idea of ​​the prevalence of this disease. Domestic and foreign authors provide only selective data, and information about the frequency of abscesses relative to the population practically does not exist. For example, there is evidence that in France the number of hospitalizations with lung abscess is about 10 people per year. According to statistics from the Massachusetts State Hospital of 1944, 10.8% of 10,000 admitted patients were diagnosed with lung abscess.

Under lung abscess understand the appearance of purulent or putrefactive disintegration of necrotic sections of lung tissue with the formation of one or more cavities filled with pus and located more often within the segment. This purulent cavity (abscess) is usually surrounded by a pyogenic capsule, as well as a zone of inflammatory infiltration of lung tissue, which separates it from unaffected tissues.



Contributing factors

Pulmonary suppurations occur more often with:

  • violation of bronchial patency;
  • the development of acute infectious inflammatory processes in the lung parenchyma;
  • circulatory disorders with subsequent development of lung tissue necrosis.

Chronic alcohol intoxication and drug addiction is characterized by an aspiration route of infection due to a weakening of the cough reflex and a decrease in the level of consciousness. In addition, these conditions have a detrimental effect on the already developed purulent process in the lungs, since protective reactions are suppressed in the body of drug addicts and alcoholics. In such patients, as a rule, there is an extensive lesion of the lung tissue with frequent development of pyopneumothorax, pleural empyema and intoxication psychosis.

With a long course of chronic diseases of the respiratory system (bronchitis, emphysema, pneumosclerosis, bronchial asthma, chronic pneumonia), the body’s defenses are significantly inhibited, which also adversely affects the course of the resulting purulent-destructive process in the lungs. Similar conditions also occur with steroid hormone therapy. As a result of hormonal therapy, the body becomes more susceptible to infection, and the microbial flora is more resistant to antibiotics. In addition, wound healing slows down as a result of reduced capillary proliferation, collagen deposition and the formation of fibroblasts.

Thus, the development of lung abscess and other pulmonary suppuration is promoted by a weakened general condition of the body as a result of alcohol intoxication, drug addiction, inflammatory diseases of the respiratory organs, severe systemic diseases, and also in old age. These conditions contribute to the unhindered reproduction of pathogenic microflora, which, in combination with impaired local blood circulation and bronchial patency, is the main cause of lung abscess and other pulmonary suppurations.

Recently, a decrease in the role of less pathogenic organisms (pneumococcus, streptococcus) and an increase in the content of antibiotic-resistant microflora (anaerobic, gram-negative flora, streptococcus) has been observed. Associations of pathogenic microbial flora with Pseudomonas, E. coli, mycoplasma, yeast, influenza virus, etc. have become a frequent find.

Ways of lung abscess

Depending on the development paths, there are:

  • Pneumiogenic (postpneumonic) lung abscess, arising as a complication of bacterial pneumonia in 63-95% of cases.
  • Bronchogenic abscess of the lung, developing as a result of the destruction of the wall of bronchiectasis and the spread of inflammation on the lung tissue with its subsequent necrosis, suppuration and the development of the cavity - abscess. Such abscesses are more often multiple. This type of abscess often occurs due to the aspiration mechanism in people suffering from alcoholism, drug addiction, epilepsy, as well as head injuries, accompanied by prolonged loss of consciousness.

Other mechanisms of lung abscess development should also be noted:

  • hematogenous-embolic (with septic endocarditis, purulent thrombophlebitis of the veins of the extremities and pelvis, as well as abscesses in other areas);
  • obstructive (as a result of blockage of the bronchus with a tumor or a foreign body);
  • post-traumatic (as a result of compression, bruises, gunshot or knife wounds).



Symptoms and diagnosis of lung abscess

The development of lung abscess is indicated by the appearance of:

  • temperature reaction
  • pain syndrome
  • cough with purulent sputum,
  • putrid breath,
  • weakened breathing
  • symptoms of intoxication,
  • hemoptysis.

Symptomatology depends on the degree of drainage through the affected bronchus. Depending on this, a blocked abscess may develop in the absence of drainage, an abscess with insufficient bronchial drainage, or with good bronchial patency. The most severe course is observed with a blocked abscess. As a result of an increase in pressure in the abscess cavity and the involvement of the visceral pleura, severe chest pains occur. Cough dry, may cause a slight amount of sero-purulent sputum due to pneumonia or bronchitis. Observed symptoms of intoxication (loss of appetite, weakness, shortness of breath, poor sleep, fatigue, tachycardia ). Characterized by high fever, chills, pouring sweat.

Examination revealed tenderness during palpation (palpation) of the affected area, lag in breathing, shortening of percussion sound. X-ray and tomogram revealed inflammatory infiltrate in the form of a homogeneous darkening. When an abscess is breached in a bronchial tree, a copious amount of purulent sputum appears with an unpleasant odor, sometimes with blood. Usually, after the separation of pus, the body temperature decreases and the general condition of the patient improves. On the radiograph, the appearance of a clearing in the center of the darkening corresponding to the formed abscess cavity filled with gas and liquid with a clear horizontal level is noted.

For the diagnosis of acute abscess take into account the data of anamnesis, assess the general condition of the patient, as well as data of clinical, laboratory, functional, immunological and radiological methods of examination. In some cases, it is difficult to distinguish between acute abscess and gangrene of the lung on the basis of symptoms and x-ray examination results. Typically, gangrene is characterized by the progression and development of complications, the general depletion of the body, anemia and significant cardiopulmonary failure are rapidly developing. The most reliable criterion in the differential diagnosis of these two states is an x-ray examination in dynamics, which is compared with clinical manifestations. An important role in this belongs to the tomography, with which it is possible to determine the structure of the affected area at different depths, the patency of the draining bronchi, the identification of sequesters.

For the differential diagnosis of abscess and tumor diseases of the lungs, data from endoscopic and radiological studies are used. A crucial role is played by conducting diagnostic bronchoscopy and the subsequent study of the biopsy. In case of peripheral "cavitary" forms of cancer, a puncture biopsy is performed.

Symptoms of lung abscess may resemble a tuberculous lesion. In this case, tuberculosis in the sputum or evidence of immunological methods for the diagnosis of tuberculosis is evidence of tuberculosis. Of other diseases that have similar clinical manifestations, it should be noted purulent processes in the pleural cavity (empyema and pyopneumothorax), festering congenital pulmonary cysts, lung actinomycosis.

Complications of acute lung abscess

The most frequent complications include the development of:

  • pyopneumothorax;
  • pleural empyemas;
  • pulmonary hemorrhage;
  • pathological process in the opposite lung;
  • pneumopericarditis;
  • sepsis.

The most common development is pyopneumothorax and pulmonary hemorrhage. Pneumopericarditis is a rare but extremely dangerous complication of lung abscess. In this case, a sudden deterioration of the patient's condition occurs, accompanied by the appearance of subcutaneous emphysema of the upper half of the body, neck, head, and collapse.

Acute lung abscess in some cases can be cured spontaneously, but the transition to the chronic form is more characteristic. Chronic abscesses are more often found in the II, IV, IX, X segments of the lung, more often on the right, that is, in the place of foci of acute bronchopneumonia and acute lung abscess. Chronic abscess is characterized by early involvement in the process of lymphatic drainage of the lung with the development of fibrosis and lung deformity.

Principles of conservative treatment of lung abscess

In acute uncomplicated lung abscess, therapy is used to:

  • restoration of the drainage function of the bronchi (expectorant drugs, inhalation. postural drainage, transnasal catheterization of the bronchi, bronchoscopic sanation, microtracheostomy, puncture or percutaneous drainage of the abscess cavity);
  • fight against microbial flora in the center of suppuration;
  • stimulation of the body's defenses;
  • relief of clinical manifestations (symptomatic therapy).

The outcome of conservative therapy usually depends on how quickly the natural drainage of the purulent cavity is restored. This is easier to achieve with liquid pus and small sequesters. The choice of treatment method depends on the features of the pathological process, mainly on the state of bronchial drainage.

For the outflow of purulent contents from the cavities of the lung, postural drainage (position drainage) is used in combination with breathing exercises, massage and pounding of the chest. It is especially important to carry out postural drainage in the morning to clear the bronchi from the sputum accumulated overnight.

Improving the patency of the draining bronchi promotes inhalation, intratracheal drug infusion, as well as the use of expectorant drugs. The effectiveness of treatment has increased with the appearance of proteolytic enzymes (himopsina, trypsin, elastase, ribonuclease, etc.), contributing to the dissolution of small sequesters and purulent plugs.

In the absence of a positive effect from the use of these methods for 3-5 days and while maintaining the level of fluid in the abscess cavity, more active instrumental methods of drainage and sanitation are used. A good effect is observed with the use of segmental catheterization of the bronchi, in which sub-narcotic bronchoscopy is performed, with the introduction of a radiopaque controlled catheter into the draining bronchus or directly into the abscess cavity under the control of X-ray television. At the same time, purulent contents are removed from the abscess cavity, it is washed, followed by the introduction of proteolytic enzymes and antibiotics. Another method of segmental catheterization of the bronchi is with the help of a Selcheder tracheal puncture. In this case, the catheter is placed in a bronchus abscess draining for several days.

A mandatory method of treatment is bronchoscopic sanation, which allows maximum removal of purulent sputum under visual control.

Antibacterial therapy is used to influence the microbial flora. At the same time, the greatest effect is observed when creating high concentrations of antibacterial drugs in the festering nidus. For this purpose, intravenous administration of antibiotics or direct administration of drugs into the pulmonary artery, as well as the endolymphatic route of administration and interstitial electrophoresis are used.

Immunomodulating therapy is used to increase the body's immune defense. Severe patients are prescribed immuno-substitutive (administration of native hyperimmune plasma, leukocyte mass, polyvalent human immunoglobulin, etc.), adaptogenic therapy (use of biostimulants - aloe, ginseng tincture, eleutherococcus), vitamins, etc. Improving the immune system. (plasma adsorption, plasmapheresis, hemosorption, lymphosorption, etc.), due to which the removal of toxins occurs, reduces the toxic-antigenic load on the body and ul chshaetsya efficiency of the immune cells.

Conservative therapy allows for complete or clinical recovery in all patients with acute lung abscess with good bronchial drainage. In the absence of effect, as well as the appearance of complications (for example, massive pulmonary hemorrhage), it is necessary to use artificial methods of external discharge of pus: puncture of the pulmonary abscess, drainage using thoracocentesis or pneumotomy.

Surgical treatment methods

Surgical treatment of lung abscess is carried out by several methods:

  • By draining the abscess (thoracocentesis, thoracotomy and pneumotomy).
  • With the help of lung resection.

Surgical treatment is aimed at the rapid and maximum removal of pus and dead skin tissue of the lung.


| 14 December 2014 | | 2,029 | Respiratory diseases
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