Internal illnesses. Lung gangrene (most important)

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Internal illnesses. Lung gangrene (most important)

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31. GANGRENE OF THE LUNG

Gangrene of the lung is a progressive necrosis and hypochorous (putrefactive) decay of the lung tissue, not prone to limitation.

The disease is inherited by a recessive type, as a rule, it is not transmitted from parents to children.

Etiology. The causative agents of the disease are non-clostridial anaerobes.

Diseases such as chronic alcoholism, diabetes mellitus, and pneumonia in weakened patients predispose to the development of lung gangrene. The immediate causes may be: penetration of foreign bodies into the respiratory tract, lobar pneumonia, abscess or echinococcus in the lung; various diseases of the blood vessels.

There are immunological and non-immunological forms of lung gangrene; there are also a number of options: atopic, infectious-allergic, dishormonal, autoimmune, neuropsychic, adrenergic imbalance, primary altered bronchial reactivity, cholinergic.

Pathogenesis. Anaerobic bacteria penetrate into the lung tissue, activation of bacterial exotoxins and their direct effect on lung tissue, progressive lung tissue necrosis, vascular thrombosis in the affected area, impaired formation of granulation tissue.

Clinic. The main manifestations of the disease are cough with foul-smelling sputum and fragments of lung tissue, hectic fever, chest pain, shortness of breath; percussion at the onset of the disease reveals expanding dullness; during the peak period - the appearance of areas of tympanitis due to the formation of cavities. On palpation, pain is determined over the affected area (Kiessling's symptom) and percussion (Sauerbruch syndrome) (involvement of the pleura in the process), palpation - first, an increase in vocal tremors, then a weakening. Auscultation is heard, first bronchial breathing, then a sharp weakening of breathing.

Additional diagnostic study. A general blood test is performed, where neutrophilic leukocytosis is determined with a sharp shift to the left, increased ESR. A study of sputum is also carried out (during macro-examination, sputum forms 3 layers: the upper one is foamy, liquid; the middle one is serous; the lower one is fragments of decaying lung tissue; micro-examination is the study of flora, cytology), X-ray examination (massive infiltration without clear boundaries with the presence of multiple confluent cavities irregular shape).

Differential diagnosis. Should be carried out with tuberculosis, lung cancer.

Flow. The course of the disease is severe and progressive.

Treatment. Antibacterial therapy is carried out (parenterally, intravenously), possibly injected into the pulmonary artery. They combine several types of antibacterial drugs. Detoxification therapy is carried out (reopolyglucin, hemodez, hemosorption, ultraviolet irradiation of autologous blood), bronchospasmolytic therapy, endoscopic sanitation of the bronchi with subsequent administration of antibiotics, enzymes, antiseptics, blood transfusion (in case of anemia development), heparin is used (to prevent disseminated intravascular coagulation syndrome).

Prevention. Preventive measures include adequate treatment of acute pneumonia, adequate bronchial drainage, rehabilitation of chronic infection foci, smoking cessation.

Author: Myshkina A.K.

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