Lung abscess

The reason most often is:

• pneumonia caused by staphylococcus , klebsiella , anaerobes , as well as contact infection with pleural empyema , subphrenic abscess ;
• aspiration of foreign bodies, infected contents of the sinuses and tonsils .

Indirect causes include

• septic emboli that enter the hematogenous pathway from foci of osteomyelitis , gonitis, prostatitis , the lymphogenous pathway is less common - skidding with furuncles of the upper lip, phlegmon of the bottom of the oral cavity.
• Multiple abscesses, often bilateral, occur as a result of septicopyemia .

Lung abscess may be

• complication of pulmonary infarction
• decay of a cancerous tumor in the lung

An acute abscess with perifocal inflammatory lung tissue infiltration can become chronic with the formation of a dense pyogenic membrane.

It is more common in middle- aged men , 2/3 of patients abuse alcohol . The disease begins acutely: chills , fever , chest pain . After a breakthrough of pus in the bronchus , a large amount of purulent sputum is released, sometimes with an admixture of blood and an unpleasant odor. First, weakened breathing is heard over the zone of lung damage, after a breakthrough of the abscess - bronchial breathing and moist rales. Within 1-3 months, a successful outcome can occur: a thin-walled cyst in the lung or focal pneumosclerosis; adverse outcome - the abscess becomes chronic.

When radiography of the lungs, massive dimming is detected in the initial stage, after an abscess breakthrough, a cavity with a liquid level in it. Bronchoscopy most often shows inflammatory changes in the wall of the bronchus associated with an abscess. In the blood test - leukocytosis , a shift in the leukocyte formula to the left, an increase in ESR .

Abscess of the lung, lung gangrene

A lung abscess is a purulent fusion of a portion of the lung followed by the formation of one or more cavities, often delimited by the fibrous wall from the surrounding lung tissue. Lung gangrene is characterized by necrosis and putrefactive decay of lung tissue. It is caused by an anaerobic (putrefactive) infection . Suppuration of the lungs most often occurs as a complication of acute pneumonia , bronchiectasis, as well as when a foreign body enters the bronchi , with a lung wound or with a tumor. Less commonly, an infection enters the lung from distant foci of inflammation hematogenously or through the lymphatic vessels .

Acute lung abscess

Before opening into a draining bronchus, an abscess of the lungs manifests itself in a fever with sweat , chills , malaise, dry cough , sometimes chest pains of an indefinite nature. After a cavity breakthrough, a cough appears in the bronchus, accompanied by the release of purulent sputum with an unpleasant odor, sometimes with an admixture of blood . Before emptying the abscess, blunting of percussion sound and weakening of breathing in the affected area can be determined. After the formation of a cavity, voiced coarse bubbling rales are heard above it, bronchial breathing with an amphoric hue. With percussion, you can find a sound with a tympanic hue. Before the formation of the cavity, the diagnosis of lung abscess is difficult. Pulmonary suppuration should be suspected with prolonged pneumonia with a prolonged increase in body temperature and persistent leukocytosis . When an abscess breaks into the bronchus, a cavity is detected radiographically in the former darkening area.

Chronic lung abscess

It arises as the outcome of an adverse course of acute abscess or bronchiectasis. It has a denser capsule with the development of pulmonary fibrosis around it. Along with the radiological signs of a cavity in the lungs, a patient has an increase in temperature, a cough with purulent sputum, fingers in the form of drumsticks , nails in the form of watch glasses. The disease flows in waves, with periodic exacerbations of acute fever, an increase in the amount of typical three-layer sputum. With a long course, complications are possible: amyloidosis , cachexia , septicomipemia with an abscess of the brain , etc. Treatment . Conservative - antibiotics, therapeutic bronchoscopy allow you to stop an exacerbation. The main method remains surgical: excision of the affected area of ​​the lung.

Improving the drainage function of the bronchi ( bronchodilators , expectorants , inhalations , repeated therapeutic bronchoscopy ). When the abscess is located in the lower lobes, the position is drained, raising the foot end of the bed by 20-30 cm Antibiotics in large doses, stimulating the body's defenses (high-calorie diet, proteins , vitamins , levomizole, T-activin , antistaphylococcal plasma and gammaglobulin, hemosorption , plasmapheresis ) With inefficiency after 2-3 months - surgical treatment. Timely initiated treatment usually leads to recovery.

With treatment failure for 6-8 weeks. the patient must be hospitalized in a surgical hospital for bronchoscopic drainage or surgery. Lung gangrene is rare, is characterized by a severe course, severe intoxication, coughing up chocolate-colored sputum with a fetid odor. Broad-spectrum antibiotics are prescribed parenterally; with their ineffectiveness, surgical treatment is indicated.

Surgical treatment of abscesses consists in the rehabilitation of the abscess cavity. Perhaps percutaneous puncture. Rg is performed - lung examination with labeling on the area of ​​the proposed puncture. Then, in the same way as during thoracentesis, a puncture is performed, a drainage tube is inserted into the abscess cavity. Next, complex antibacterial therapy is prescribed. Another option for surgical treatment is bronchoscopic sanitation of the abscess (performed with a fairly close location of the abscess to the main bronchus).

Timely vigorous treatment of respiratory tract infections, especially pneumonia, prevention of aspiration, especially after injuries, surgery, etc.

The forecast is conditionally favorable. Most often, patients with a lung abscess recover. However, in half of patients with acute lung abscess, thin-walled spaces are observed, which disappear with time. Significantly less often, a lung abscess can lead to hemoptysis, empyema , pyopneumothorax , broncho-pleural fistula .

The most typical sign at the onset of the disease is the sugary sweet smell that stands out from the nasal cavities, which soon becomes fetid. This smell is felt throughout the room and even persists for a day or more after removal of the patient. Following the smell, a bilateral outflow from the nose of a brown-gray-reddish or greenish color appears. The disease occurs at a high body temperature, accompanied by cough, shortness of breath, weakening of cardiac activity and other common symptoms. ^[3]

• Petrov S.V. General Surgery: Textbook for high schools. - 2nd ed. - 2004 .-- 768 p. - ISBN 5-318-00564-0 .