Lung Abscess - Causes, Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Lung abscess: what is it and how to treat it?

Inflammation of the lung tissue of a nonspecific nature, provoking its melting in the form of a focus with clear boundaries and the formation of cavities with purulent-necrotic contents, is a lung abscess. It occurs as a result of an infection that causes necrotic tissue to form and accumulate pus. In most cases, it occurs due to the ingestion of the contents of the oral cavity into the lungs while a person is unconscious.

Treatment of pathology is carried out with antibacterial drugs from the group of beta-lactam antibiotics. In 7-10 patients out of a hundred, after 2 months from the onset of the disease, the lung abscess becomes chronic. Approximately 5% of cases of the acute form of the disease and 15% of all cases of chronic lung abscess are fatal.

Content:

• Reasons for the formation of an abscess
• Pathogenesis of the acute form of the disease
• Classification of lung abscesses
• Lung abscess symptoms
• Diagnostics
• Lung abscess treatment
• Chronic lung abscess

Reasons for the formation of an abscess

Pathogenic microorganisms enter the lungs through the bronchogenic route. It is extremely rare that an abscess in the lungs is provoked by pathogens that have got there hematogenously through the circulatory system.

Causative agents of the disease:

• Anaerobic bacteria - gram-positive and gram-negative bacilli;
• Cocci (staphylococcus, streptococcus);
• Aerobic bacteria - gram-positive and gram-negative bacilli;
• Mushrooms;
• Parasites (causative agents of echinococcosis, amebiasis, paragonimiasis).

The reasons for the appearance of an abscess:

• Aspiration of secretions from the oral cavity in patients with a history of gingivitis, tonsillitis, periodontal disease, who do not follow the rules of oral care, while taking alcohol, drugs, sedatives, opioids.
• Ingestion of the contents of the oral cavity in the lungs in elderly patients and in patients with neurological pathologies that provoke a helpless state.
• Complication of necrotizing pneumonia in the form of seeding of the lungs with septic emboli, as a result of purulent thromboembolism, intravenous drug injection. The hematogenous route of infection provokes multiple lung abscesses.
• Injury of the chest;
• Infection of the lung as a result of his heart attack due to pulmonary embolism.
• Aspiration of vomit or foreign bodies.
• Bacteremia (sepsis).
• The presence of a cancerous tumor of the lung, Wenger's granulomatosis, nodular silicosis in anamnesis.

Pathogenesis of the acute form of the disease

At the beginning of infection, the lung tissue undergoes inflammation, a limited infiltration is formed. With the development of the disease, the infiltrate from the center to the periphery undergoes purulent fusion. A cavity is formed, lined with granulation tissue, an area of pneumosclerosis is formed.

The area that has undergone necrosis is converted into an abscess. If it breaks into the bronchus, the purulent contents of the abscess are cleared up. The remaining cavity is filled with liquid and air. In case of an unfavorable outcome, when the purulent process becomes chronic, the infection in the cavity is maintained for a very long time, the inflammatory focus is not cleared.

Complications of chronic lung infection:

• pyopneumothorax;
• sepsis;
• pulmonary bleeding;
• bacteremic shock;
• empyema of the pleura;
• respiratory distress syndrome.

Pulmonary bleeding occurs as a result of damage to the bronchial arteries. In this case, from 50 to 500 ml of blood is released. Signs of pulmonary hemorrhage are secretion when coughing or spontaneously sputum mixed with foamy scarlet blood. The patient becomes pale, he has a rapid pulse and a decrease in blood pressure. In severe cases, bleeding of the bronchial arteries causes death of the patient.

Classification of lung abscesses

When classifying a disease by etiology, attention is paid to the causative agent of the pathology.

By pathogenesis, they are guided by the path of infection:

• Bronchogenic,
• Traumatic,
• Hematogenous.

By location in the lung tissue, there are:

• Central abscess;
• Peripheral abscess.

In count:

• Unit,
• Multiple abscess.

A lung abscess can be located in one or both lungs (bilateral process).

Lung abscess symptoms

Before the breakthrough of the abscess into the bronchi, the following pathology symptoms are distinguished:

• Dripping sweat;
• Severe hyperthermia of high values;
• Signs of respiratory failure (inability to take a deep breath, shortness of breath, shortness of breath);
• Dry cough;
• Chest pain when coughing, occurs on the affected side;
• When listening with a phonendoscope, weakened hard breathing, muffled heart sounds are distinguished;
• With percussion - shortening of the sound over the abscess area;
• Cyanosis of the skin;
• The patient's desire to take a forced position;
• Frequent arrhythmic pulse;
• Lowered blood pressure, with shock - a sharp drop in blood pressure.

After the abscess breaks through the bronchial cavity, the patient begins an attack of coughing, ending with the release of a large amount of purulent sputum with an unpleasant odor. On average, 100 to 150 ml are released.

Symptoms after abscess breakthrough:

• Decrease in temperature;
• Improving general condition;
• When listening - fine bubbling rales;
• With percussion - shortening of the sound over the abscess area.

After 1.5-2 months, the symptoms of the disease do not appear. If drainage of the lung is difficult, symptoms of the inflammatory process remain. The patient has difficulty coughing up fetid phlegm, he has the following characteristic symptoms:

• Dyspnea;
• Dripping sweat;
• Chills;
• The last phalanges of the fingers take the form of "drumsticks";
• Fingernails become like "watch glasses".

Expectorated sputum, when kept in a container, is divided into fractions:

• The lower one is a thick dense layer of tissue detritus;
• Medium - liquid pus with saliva;
• Upper - foamy serous fluid.

The patient can discharge up to a liter of sputum per day. Its amount depends on the volume of the cavity formed by the abscess.

Diagnostics

The most informative method for diagnosing lung abscess is radiography. Before the breakthrough of the abscess, an infiltration in the lung tissue is noticeable in the image; after the breakthrough of a purulent formation, a bright spot with a horizontal level of fluid is fixed. This test will help to make an accurate diagnosis and differentiate it from other lung diseases.

Additional instrumental methods:

• MRI, CT of the lungs - is performed if there is a suspicion of lung cavitation or if the bronchi are compressed by a large formation;
• Spirography;
• Bronchoscopy - allows you to exclude malignant lung tumors;
• Peakfluometry;
• ECG.

To exclude pleurisy when similar symptoms appear, a pleural puncture is performed.

Laboratory diagnostics - methods and indicators that confirm the disease:

• Complete blood count - at the first stage, leukocytosis, increased ESR level, a shift in the leukocyte formula, at the second stage, the indicators approach normal, during the transition to the chronic stage - signs of anemia, the ESR level is stable.
• General urine analysis - microhematuria, albuminuria, presence of protein;
• Biochemical blood test - an increase in the amount of fibrin, haptoglobin, β-globulin.
• General analysis of sputum - the presence of atypical cells, fatty acids, mycobacterium tuberculosis, elastic fibers;
• Sputum bacterioscopy - identification of the pathogen;
• Bacterial culture of sputum - determination of the sensitivity of the pathogen to antibacterial drugs.

Based on the results of the diagnostic examination, the doctor determines the tactics of treatment, focusing on the severity of the patient's condition.

Lung abscess treatment

This disease is treated in an inpatient setting in the department of pulmonology. In the acute stage, the patient is shown bed rest. Several times a day, for 10 to 30 minutes, it is placed in a draining position to stimulate the outflow of sputum.

Possible manipulations and treatment procedures:

• Treatment with antibiotics that are effective against the type of pathogenic bacteria that have struck the lung - Clindamycin, Ampicillin-sulbactam, Metronidazole, Ceftriaxone, Cefotaxime, Amoxicillin-clavunalate;
• Blood transfusion, autohemotransfusion - activates the patient's immunity;
• Prescribing antistaphylococcal globulin and gamma globulin if necessary;
• Bronchoalveolar lavage - washing the abscess cavities with antiseptics;
• Transtorecal puncture on large peripheral abscesses;
• Tracheotomy and sputum aspiration in debilitated patients;
• Percutaneous or surgical drainage of abscesses;
• Drainage of concomitant empyema;
• Lung resection with ineffectiveness of conservative therapy, multiple abscesses, gangrenous tissue damage.

The average duration of treatment for a lung abscess is 3-6 weeks, with large formations and multiple lesions, it is extended to 6-8 weeks.

Chronic lung abscess

The causative agents of the chronic form of the disease are the same as in the acute form of pathology - fungi, gram-negative and gram-positive bacilli, various strains of staphylococcus.

It is not easy to diagnose the transition of the disease into a chronic form, because its symptoms can be minimal, be in remission. Improvement of methods of diagnosis and treatment of acute lung abscess led to a decrease in the number of its transitions to a chronic form.

Clinical manifestations of the chronic form:

• Intoxication symptoms (headache, weakness, rapid fatigue);
• Frequent cough;
• Chest pain on the affected side;
• Feeling short of breath;
• Disruption of the work of other organs of unknown etiology.

Reasons for the transition of the disease to a chronic form:

• The presence of multiple or too large abscesses;
• With ineffective drainage, a fibrous capsule was formed, covered with connective tissue, which makes it difficult to reduce the abscess cavity;
• The presence of sequesters in the abscess cavity, which impede full drainage;
• After treatment, a dry residual cavity was formed;
• Reduced immunity, inadequate response of the body to treatment;
• The presence of pleural adhesions in the lung, preventing the destruction of the abscess cavity.

The presence of a chronic inflammatory process negatively affects the functioning of the body. Chronic hypoxia and intoxication with waste products of pathogenic bacteria, imbalance in the activity of the endocrine and nervous systems leads to dangerous consequences:

• Formation of pulmonary hypertension;
• Violation of microcirculation in the tissues of various organs;
• The appearance of immunodeficiency;
• Violation of protein and energy metabolism.

Chronic lung abscess can be complicated by pulmonary hemorrhage, the development of sepsis, secondary bronchiectasis, parenchymal amyloidosis.

Chronic abscess treatment. The only effective treatment is surgery to remove a cavity with pus from the lung. Since the patients are significantly weakened, careful preparation for the operation is required.

Preparation methods:

• Sanitation of the purulent cavity with antiseptics;
• Fighting the consequences of intoxication;
• Correction of the general condition of the patient's body to increase immunity and reserve capabilities.

After the operation, it is important to pay special attention to the patient's rehabilitation to prevent postoperative complications.

In resuscitation, special attention is paid to the restoration of blood circulation and respiratory function, the prevention of infectious lesions. After straightening the operated lung, restoring normal blood counts, and the patient's ability to get up and walk on their own, it can be considered that the operation was completed successfully.

To prevent the formation of a lung abscess, it is necessary to timely treat diseases of the respiratory system, sanitize the oral cavity and foci of chronic infection.

Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist

Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".