Purulent inflammation occupies a special place among surgical infections and affects many organs and systems, including the respiratory one. One of the dangerous pathologies of the respiratory system is classified as a lung abscess.
General characteristics of the disease
Lung abscesses are pathological formations of a purulent-destructive nature, limited from healthy tissues by a capsule. They can be both single and multiple. They develop against the background of other infectious diseases of the respiratory system or other organs, more often in adult men, rarely in a child. Diagnostics and treatment is carried out in a surgical hospital.
Classification
Lung abscesses are classified according to:
- cause of occurrence (the type of microorganism that caused purulent inflammation);
- pathogenetic picture;
- the presence of one or more abscesses;
- by location: central or peripheral.
Causes
The infectious component of the appearance of an abscess in the pulmonary parenchyma can be of various etiologies: from bacteria living in an oxygen environment to dangerous anaerobic microorganisms.
Abscesses occur in patients:
- prone to aspiration of the respiratory tract with infected contents of the oropharynx (epilepsy, state of anesthesia);
- patients with pneumonia;
- HIV-infected;
- for a long time suffering from periodontal disease, chronic gingivitis and tonsillitis.
Predisposing factors:
- diabetes mellitus – increases the possibility of developing various purulent complications;
- bronchiectasis – purulent sputum can get into healthy areas of the lungs;
- chronic alcoholism – a decrease in the body’s defenses as a whole.
Secondary abscesses occur in patients with sepsis – blood poisoning. With the blood flow, bacteria penetrate into the lungs, where they begin their pathogenic effect on healthy tissue. Also, sluggish sepsis can cause chronic lung abscesses.
However, it is worth emphasizing that the pathogenesis of lung abscess suggests that it is always secondary and is formed due to the transfer of infection from another focus in the body.
Symptoms
The mechanism of development of the disease takes place in two clinical stages:
- The stage of formation of an abscess from healthy tissue with its encapsulation and the formation of purulent exudate.
- The stage at which the abscess stops abscessing, and it breaks out of the capsule.
The onset of the disease is characterized by:
- chills;
- pain in the chest during breathing;
- shortness of breath, mainly with difficulty in exhaling;
- fever up to high rates and fever;
- intoxication of the body leads to loss of appetite, headache, sometimes vomiting after eating, nausea;
- the clinic is often blurred and not immediately characterized by all of the above symptoms, due to which the degree of danger of the disease can be incorrectly assessed.
The stage (period) of abscess formation (abscess growth) lasts up to 2-3 weeks, usually 7-10 days. Further, the contents exit from the capsule. After the breakthrough of pus, the patient coughs with a large volume of purulent sputum. It is a foul-smelling liquid with an unpleasant odor.
Diagnostics
Measures to identify the disease begin with a survey of complaints that characterize most of the subjective symptoms of an abscess. After that, the doctor examines the patient and uses physical examination methods (palpation, percussion, listening). The presence of an abscess in the lungs is indicated by:
- lag of the diseased half of the chest during the act of breathing;
- soreness when feeling the intercostal spaces, which indicates a reaction to the pathological process of the intercostal pleura – the membrane that lines the chest cavity;
- voice tremor increases;
- listening shows a weakening of normal (vesicular) breathing and the appearance of a bronchial shade on the diseased side;
- percussion shows dullness of percussion sounds, normally the sound above the surface of the lungs is clear, pulmonary.
The patient is prescribed additional studies, which include:
- general and biochemical blood tests;
- Analysis of urine;
- sputum analysis;
- X-ray of the lungs;
A general blood test shows an increased content of leukocytes (up to 20×109 / l), an increase in ESR (erythrocyte sedimentation rate), which indicates inflammation.
The X-ray picture at the onset of the disease is a darkening of the lung tissue without reducing its volume.
The second period of the disease on the roentgenogram – against the background of decreasing infiltration of the lung tissue, enlightenment of a round shape is noticeable, indicating the formed cavity.
Differential diagnosis is carried out using tomographic examination. The leading method is the X-ray of the lungs. As soon as the abscess can be accurately diagnosed in the emergency department, hospitalization is made in surgery for the appointment of special treatment.
Treatment
Treatment is divided into 2 categories:
- therapeutic treatment in a surgical hospital;
- resolution of the abscess by surgical methods.
The first implies:
- adherence to bed rest;
- isolation from other patients with fetid discharge from the mouth, as the patient becomes contagious;
- the appointment of a varied, high-calorie diet with a large amount of natural vitamins;
- the use of postural drainage: several times a day the patient takes a comfortable position in which he subjectively clears his throat better;
- supportive drug therapy;
- antibiotics are prescribed (the choice is made by the doctor).
Doctors select antibacterial agents depending on the detected microflora. Aerobic (oxygen-breathing) bacteria require penicillin and cephalosporin therapy. Anaerobic (able to live without oxygen) microorganisms are treated with large doses of penicillins, Levomycetin. Often transfusion of blood and plasma components is carried out to increase the defenses of the sick organism.
If the cavity is not drained naturally enough (sputum leaves a little), then carry out:
- therapeutic bronchoscopy with active suction of pus and subsequent rinsing of the cavity with antiseptic agents;
- a large cavity and its peripheral position serve as indications for puncturing the chest. This method allows you to evacuate purulent contents.
A radical operation is performed with complicated abscesses or with complete ineffectiveness of conservative treatment.
After the treatment of a lung abscess and in the recovery phase, physiotherapy, spa treatment, massage and physiotherapy exercises and gymnastics are recommended.
Complications
With a severe course or refusal to treat a lung abscess, complications and syndromes occur that can lead to a significant deterioration in the quality of life and death:
- purulent pleurisy and pneumothorax (the process extends to the pleural cavity);
- pulmonary bleeding;
- multiple abscesses of healthy tissue;
- septic damage to the body (blood poisoning) with the subsequent appearance of abscesses in other organs (metastasis of an abscess);
- the outcome of the latter condition is often such a serious condition as bacteremic shock.
Forecast and prevention
In most cases, the patient recovers, the abscess cavity is overgrown. To control the quality of treatment, a chest X-ray is performed 3 and 6 months after the end of treatment. The general percentage of lethality (death) is 5-10%.
Preventive measures also include:
- mandatory thorough treatment of acute pneumonia;
- rehabilitation of chronic infectious foci in the oral cavity and nasopharynx is important;
- reducing the systematic use of alcohol and limiting the inhalation of foreign bodies and substances.
Any purulent process is a severe surgical pathology, which, as a prerequisite, requires qualified intervention in order to effectively treat it. Complications of both an abscess of the lungs and other purulent inflammations can lead to serious consequences, from the patient’s disability to his death.
Trying on individual symptoms for yourself, any recommendations on taking medications and methods of treatment, including folk, not supported by the qualifications of a specialist, will only bring harm. And the craving for treatment at home and a delayed visit to the doctor will aggravate the situation.