Internal illnesses. Lung abscess (lecture notes)

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Internal illnesses. Lung abscess (lecture notes)

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LECTURE No. 25. Lung abscess

Lung abscess - a limited purulent inflammation of the lung tissue with the destruction of its parenchyma and bronchi, their melting and the formation of a cavity.

Etiology. The etiological factors of abscess are bronchial obstruction by foreign bodies, acute pneumonia, bronchiectasis, chest trauma, hematogenous embolization by infection.

Pathogenesis. There is a penetration of the infectious agent into the lung tissue (bronchogenic, hematogenous, lymphogenous pathways, aspiration of foreign bodies), a violation of the drainage function of the bronchi.

Classification. According to the characteristics of the clinical course, the disease is divided:

1) by origin: acute lung abscess and chronic lung abscess (the course of the process is over 2 months);

2) by localization (segment, segments, right- or left-sided);

3) by complications.

Clinic. In acute lung abscess (AAL) secrete organization period (before opening the cavity - up to 7 days), which is characterized by an acute onset (dry hacking cough, chills), chills changing to pouring sweat (hectic fever), mental disorders, puffiness of the face, flushing of the cheeks, lagging of the affected side of the chest during breathing, local thickening of percussion sound, hard breathing with a bronchial tone, and period after cavity opening, characterized by a sudden discharge of purulent fetid sputum with a full mouth, a drop in temperature, a decrease in intoxication, the appearance of tympanitis is determined percussion over the affected area of the lung, with auscultation, amphoric breathing, moist medium and large bubbling sonorous rales. In chronic lung abscess (CAL), patients have a cough with fetid sputum, hemoptysis, chills, sweating, puffiness of the face, diffuse cyanosis, bad breath, fingers in the form of drumsticks, nails in the form of watch glasses (a sign of hypoxia), over the located auscultated amphoric breathing, moist sonorous fine bubbling rales.

Additional diagnostic study. A general blood test is carried out, in which neutrophilic leukocytosis with a sharp shift to the left is determined during the organization period, increased ESR, and in the period after opening - normalization of indicators; with CAL - neutrophilic leukocytosis with a shift to the left, an increase in ESR. An immunological examination of blood is also carried out (lymphopenia, increased activity of nonspecific and humoral parts of the immune response), sputum examination (macro- and micro-study - cytology, flora, elastic fibers), X-ray examination (during the organization period - massive darkening with fuzzy contours; after opening in bronchus - a cavity with thick, infiltrated walls and with a horizontal level of fluid; with a breakthrough into the pleura - free fluid and gas in the pleural cavity).

Complications. Complications of the disease are sepsis, pyopneumothorax, mediastinal and subcutaneous emphysema, pleural empyema, pulmonary hemorrhage, metastatic brain abscess, cor pulmonale.

Differential diagnostics. Should be carried out with pneumonia (acute and chronic), tuberculosis, lung cancer, sepsis.

Flow. The course can be acute and chronic.

Treatment. Infectious destruction of the lungs is treated only in a hospital, if possible in the department of thoracic surgery. Careful patient care is required, high-quality nutrition with sufficient amounts of protein and vitamins (diet No. 15), infusion of nutrient mixtures, drug treatment that includes antibiotic therapy (parenteral, intravenous), possible introduction into the pulmonary artery, a combination of several types of antibacterial drugs, detoxification therapy (rheopolyglucin, hemodez, hemosorption, ultraviolet autologous blood), bronchospasmolytic therapy, positional drainage, endoscopic bronchial sanitation followed by the introduction of antibiotics, enzymes, antiseptics, blood transfusion (with the development of anemia), the use of heparin (to prevent DIC), mucolytic and expectorant funds.

Author: Myshkina A.A.

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