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Lung abscess: symptoms, treatment, complications and pathogenesis

Lung abscess most often develops on the background of infectious inflammatory diseases, acting as their complication. Without correct diagnosis and timely treatment, pathology leads to serious consequences and even death.

Content

Lung abscess - What is it?

Lung abscess is a disease in which the lung tissue becomes inflamed and necrotic. As a result, cavities with purulent-necrotic contents are formed due to infection. When there are several such lesions in the lungs, they speak of necrotic pneumonia or gangrene.

The most common causes of an abscess are such pathogens as Staphylococcus aureus, aerobic gram-negative bacteria and anaerobic nonsporogenous microorganisms.

Into the lungs, microbes penetrate through the bronchi, and triggering infection and inflammation can serve not only angina, pneumonia, bronchitis and other respiratory diseases, but also oral cavity disease - for example, tonsillitis, periodontal disease, gingivitis, caries.

Less commonly, bacteria are introduced into the lung tissue with blood, that is, by the hematogenous route - from other inflammatory organs - for example, in case of purulent appendicitis.

Pathogenesis of the disease

Lung abscess scheme

Lung abscess occurs in the airless region of the tissue, which can be caused by various factors. In most cases, there is a combination of lung abscess and pneumonia. Also, purulent-necrotic cavities appear due to a foreign body with an infection falling into the lung - a small piece of carious tooth, emetic masses.

Alien bodies block the smallest ramifications of the bronchi, and in this place block the flow of air. Such a site is called atelectatic or airless, an abscess is formed here.

An abscess in the lung tissue may appear in case of bronchiectasis, the provoking factors are also elderly and old age, exhaustion and weakened immunity.

The pathogenesis of lung abscess in the purulent cavity is as follows:

  • in the lung tissue formed a limited area with inflammatory infiltrate;
  • the abscess melts the tissues from the center to the edges, forming a cavity;
  • lining of the cavity with granulation tissue occurs, and infiltration around it disappears;
  • then obliteration of the cavity is observed and a pneumosclerosis area is formed - in case of acute course;
  • but if the cavity walls are formed by fibrous tissue, the suppuration may persist for a long time, and lung abscess becomes chronic.

The risk group includes not only persons with inflammatory diseases of the oral cavity, respiratory or other organs, but also people with such problems:

  • diabetes , when the likelihood of purulent inflammation is increased several times;
  • chronic alcoholism, in which there is a risk of vomiting in the bronchi;
  • bronchiectasis - aspiration of sputum containing the infection is possible.

Classification

According to the duration of the course of the disease, lung abscess is acute and chronic. In the first case, ulcers appear as early as 3-6 weeks after the onset of the disease. In chronic abscess, foci of necrosis are formed slowly.

By origin, the disease is classified into groups:

  • on the way of infection - hematogenous, traumatic, bronchogenic;
  • pathogen - staphylococcal, pneumococcal and others.

According to the localization in the tissues, the pathological process can be single or multiple, one-sided (abscess of the right lung or left) or bilateral, central and peripheral.

Signs and symptoms of lung abscess

lung abscess symptoms Signs of acute lung abscess are manifested by a strong cough, with a discharge of purulent sputum, often with blood, pain in the chest. In chronic abscess, remission and exacerbation alternate.

During relapses, the above symptoms are observed. When remission occurs, chest pain becomes less pronounced, but more sputum with pus is released, fatigue, night sweats and coughing appear.

The symptoms are also different before and after the lung abscess breakthrough. Symptoms in the first case are:

  • purulent contents accumulate in a certain part of the lung and the general condition becomes heavy, fatigue is observed,
  • malaise;
  • loss of appetite;
  • sweating, especially at night;
  • dry, painful cough and shortness of breath;
  • temperature rise;
  • when listening, dry rales are revealed, the shortened sounds are higher than the place with the abscess;
  • the fingers are often thickened phalanges;
  • on the X-ray of the lungs visible shadow of a rounded shape;
  • a blood test shows an increase in ESR and leukocytes.

Symptoms of lung abscess after an abscess breakthrough:

  • profuse sputum - up to a liter per day;
  • improving overall health and temperature;
  • breathing becomes easier, and when listening to wheezing wet;
  • reduced sweating, improved appetite;
  • X-ray shows a rounded cavity and in the picture you can see the level of sputum in it.

The pathogenesis of abscess and its breakthrough are sometimes accompanied by complications:

  • empyema of the pleura in case of an abscess breaking into the pleural cavity;
  • profuse bleeding with severe damage to the pulmonary vessels;
  • septicopyemia - the formation of purulent metastases in various organs;
  • pulmonary gangrene;
  • pyopneumothorax, if an abscess is associated with the bronchus and breaks into the pleura;
  • impaired blood circulation and hypoxia with displacement of the mediastinum.

All of these consequences are life threatening and require immediate medical attention.

Diagnosis of lung abscess

Diagnosis of lung abscess

It is more difficult to diagnose a disease in the early stages before an abscess breaks out, and therefore it is often confused with focal pneumonia. Therefore, the diagnosis of "lung abscess" is made on the basis of not only the symptoms, but also other methods of examination:

  1. Blood test;
  2. Radiography;
  3. Listening to the lungs with a stethoscope and phonendoscope (auscultation);
  4. Percussion (tapping in order to assess emerging sounds).

Diagnostic examination of the lung

Diagnosis is facilitated after the opening of an abscess, since during this period the disease is easily recognized by the appearance of abundant sputum and cavity on an x-ray with a certain level of purulent contents.

To puncture the lung for diagnosis is rarely resorted, since this is a high risk of purulent pleurisy.

In the diagnosis of lung abscess, it is important to exclude the presence of diseases similar in symptoms, such as cavernous tuberculosis, actinomycosis, pleurisy, focal pneumonia .

Lung abscess treatment

lung abscess photo

lung abscess photo

In acute lung abscess, treatment is surgical or conservative depending on the stage of development of the pathology. In the initial phase, when only an infiltration has appeared or no more than 1-1.5 months have passed since the formation of a cavity with purulent contents, broad-spectrum antimicrobial drugs are prescribed.

These can be Streptomycin, Penicillin, Biomitsin, or other antibiotics — either one drug or a combination of two or more drugs is used. Their effectiveness is observed in the treatment of most patients with acute lung abscess.

In addition, conservative therapy includes:

  • high-calorie balanced diet with high content of proteins and vitamins;
  • blood transfusions to enhance immune defenses;
  • drug immunotherapy;
  • anabolic steroids;
  • parenteral administration of protein drugs - Albumin, Protein;
  • pyrimidine derivatives - Potassium Orotate, Methyluracil;
  • Calcium chloride intravenously.

If an abscess is communicated with the bronchus, purulent contents are removed from the necrotic cavity by the method of postural drainage or using a bronchoscope , after which antimicrobial agents are injected into it.

In most cases (about 70%), conservative therapy yields a positive result, but in a fifth of patients the acute form becomes chronic.

Death in the treatment of lung abscess occurs in 5% of cases and the same percentage of patients require surgical intervention.

The operation is carried out with a strong pulmonary hemorrhage, as well as with the intensive development of suppuration against the background of drug therapy.

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