Chronic abscess of a lung – chronic it is purulent - the destructive process which is a consequence of incomplete elimination of a sharp abscess in a lung. Proceeds with remissions and aggravations; during the sharp period cough with a large number of a purulent phlegm, breast pain, high temperature of a body, purulent intoxication, respiratory insufficiency are expressed. At diagnosis "chronic abscess of a lung" are guided by the anamnesis, data of fizikalny, radiological and endoscopic inspection. Surgical treatment of chronic abscess of a lung is performed after thorough preoperative training.
Chronic abscess of a lung
Chronic abscess of a lung – it is long the existing suppuration cavity in a lung limited to the rough fibrous capsule. 2,5-8% of cases of sharp abscess come to an end with formation of chronic abscess of a lung. Usually speak about chronic pulmonary suppuration in case sharp it is purulent - destructive process did not come to the end within 2-3 months. As morphological criteria of chronic abscess of a lung serve irreversible changes of a pulmonary parenchyma and bronchial tubes. In pulmonology chronic abscess of a lung is quite often considered as option of a course of chronic pneumonia therefore carry to the HNZL group. Chronic abscess of a lung is serious surgical pathology with high risk of development of heavy complications and a lethality.
Reasons of chronic abscess of a lung
Most often chronic suppuration is a consequence of incomplete elimination of sharp infectious process or its renewal in a residual cavity. It can be promoted by two groups of factors: the first – errors of treatment of sharp abscess, the second - features of a current it is purulent - destructive process and system reaction of an organism.
It is necessary to carry the late beginning of conservative therapy to errors of treatment of sharp abscess of a lung or before its end, inadequate selection of antimicrobic means or use of low dosages, inefficient sanitation of a purulent cavity, etc. The features of development of pathological process promoting formation of chronic abscess in a lung can include big (over 6 cm) or multiple cavities of destruction; existence of intracavitary sequesters; bad drainage of a purulent cavity through a bronchial tube (at a narrow, wavy gleam of a bronchial tube); nizhnedolevy localization of abscess; existence of the pleural unions interfering a cavity obliteration etc. Krom of the local reasons matters low resistance of an organism, bad food, deficiency of nutrients, addictions (smoking, abuse of alcohol, drug addiction), advanced age of patients.
Sometimes chronic abscesses of lungs will be organized around alien objects in a pulmonary parenchyma (fragments of edges, particles of clothes, splinters of the shells) which got as a result of the getting thorax wound. Can lead the long finding of foreign matters in a trakheobronkhialny tree which is followed by violation of a drainage of bronchial tubes to formation of chronic abscess of a lung. More rare, but as quite probable causes the deforming bronchitis, a bronchial tube sdavleniye can act from the outside at a bronkhoadenita. Among the etiologichesky microbic agents revealed at chronic abscess of a lung, the leader is pathogenic staphylococcus, it is followed colibacillus, proteas, a sinegnoyny stick.
The Patomorfologichesky basis of chronic abscess of a lung is made irreversible to changes in pulmonary fabric. The wall of an abscess is thickened, presented by rough fibrous fabric. Each aggravation of infectious process leads to distribution of a pneumosclerosis to circles of abscess, deformation of bronchial tubes, thrombosis of vessels. The Bronkhogenny rasprostrayoneniye of an infection causes an obrayozovaniye of new abscesses in a lung. The arrosion of a wall of bronchial arteries can lead to the profuzny pulmonary bleeding which is often coming to an end fatally.
Classification of chronic abscess of a lung
Depending on an origin (etiologichesky conditions) distinguish chronic abscesses of lungs: primary (at the unspecified previous disease), obturatsionny, being an outcome of sharp it is purulent - destructive process and caused by foreign matters of bronchial tubes.
According to quantitative characteristics pulmonary abscesses happen single and multiple; on prevalence of defeat - unilateral and bilateral. Taking into account a phase of a current allocate remission and an aggravation. Chronic abscesses of lungs are classified by criterion of absence/existence of complications on uncomplicated and complicated (extra pulmonary or pulmonary and pleural complications).
Symptoms of chronic abscess of a lung
Transition from sharp abscess to chronic can develop according to two scenarios. In the first case the stage of a sharp abscess comes to the end with considerable clinical improvement or recovery of the patient. Body temperature is normalized, radiological in a lung the dry cavity and a local pneumosclerosis is defined. The aggravation comes after some period of wellbeing and satisfactory health. At the second option of succession of events the sharp period at once flows in chronic, without zatikhaniye of clinical symptomatology.
Displays of chronic abscess of a lung depend on a phase of pathological process. During remission of the complaint are minimum. Most of patients disturbs cough with a mucopurulent phlegm, breast pain at a deep breath, short wind at physical activity, evening subfebrilitt, perspiration at night. The persistent blood spitting is sometimes observed. Externally sick the lowered food, have pale integuments, moderate cyanosis of lips, deformation of fingers and nails ("Hippocrates's fingers").
Exacerbations of chronic abscess of a lung usually arise 2-3 times a year, however can happen and are more often (each 2-3 months). Usually they are initiated by overcooling or a SARS. The sharp phase is characterized by strengthening of cough, noticeable change of quantity and character of a phlegm. In days patients with chronic abscess of a lung can cough up up to 500 and more milliliters of a purulent phlegm, sometimes with blood impurity. When upholding the phlegm is divided into three layers: top – colourless foamy slime; average – muddy, yellowish-greenish liquid; lower – opaque pus of yellow or greenish color. Began to smell phlegms – unpleasant, sometimes putrefactive. Body temperature increases to febrilny values, its fluctuations are followed by oznoba and plentiful sweats. Sharply appetite decreases, the indisposition amplifies, become more expressed breast pains and short wind. The aggravation can last from 2 — 3 weeks to 2 months and longer.
Against the background of heavy purulent intoxication at patients with chronic abscess of a lung the hypertrophic osteoartropatiya develops. Massive proteinaceous losses become the kakheksiya reason. Dysfunction of kidneys lead to emergence of face edemas, feet, waists. Arrozivny bleedings, secondary bronkhoektaza, , an empiyema of a pleura most often occur among pulmonary and pleural complications. Extra pulmonary complications can include visceral , a renal failure, brain abscess, sepsis. Death of patients with chronic abscess of a lung can occur both from the listed complications, and from warm and pulmonary insufficiency.
Diagnosis of chronic abscess of a lung
Most often in the anamnesis of patients with chronic abscess of a lung there is an instruction on transferred is earlier purulent - a destructive inflammation. Except data of the anamnesis, results of fizikalny, radiological, bronkhologichesky and laboratory inspection are considered. At an auskultation rattles of various caliber are defined. In the field of the pathological center in a lung considerably obtusions of a perkutorny sound.
The research of a gemogramma reveals anemia, with shift of a formula to the left, increase in SOE, toxic granularity of neutrophils. In urine the tsilindruriya, a proteinuria is defined. The gipoproteinemiya, a gipoalbuminemiya at the increased level of immunoglobulins is typical for biochemical shifts at chronic purulent process, a gipokaliyemiya. Koagulopatichesky changes are connected with increase in level of fibrinogen. As a decisive argument in diagnosis "chronic abscess" serve results of a X-ray analysis of lungs. A typical radiological picture – existence in a lung of one or several cavities of destruction with thick uneven walls and horizontal level of liquid; around a purulent cavity perifokalny changes are defined. More detailed picture of a zone of the pathological center and the pulmonary fabric surrounding abscess manages to be received by means of a computer tomography of lungs. The bronchography allows to reveal the deformed bronchial tubes and bronkhoektaza.
In the course of a bronkhoskopiya the nature of changes mucous bronchial tubes in a zone of chronic abscess is specified, the phlegm intake for carrying out microscopic and the analysis is carried out. Data of spirometry confirm violations of external breath on the restrictive or mixed type. It is necessary to differentiate chronic abscess of a lung most often with a band form of lung cancer, tuberculosis, lung actinomycosis.
Treatment of chronic abscess of a lung
Possibilities of conservative treatment of chronic abscess of a lung are limited: it allows to achieve short-term subsiding of the sharp inflammatory phenomena, but cannot eliminate the permanent patomorfologichesky changes supporting purulent process. Most often conservative therapy is only preparation for surgical intervention. Treatment of chronic abscesses of lungs is made by thoracic surgeons in the conditions of specialized offices.
In the preoperative period to the patient the high-calorific, vitaminized diet is appointed. For the purpose of the maximum suppression of an infection in the pulmonary center antibacterial medicines taking into account sensitivity of microflora as it is system, and locally are appointed (introduction to the center through a drainage or endobronkhialno). For the best otkhozhdeniye of a phlegm expectorant, bronkhorasshiryayushy means, fermental medicines, including in the form of inhalations are shown. Local sanitation of a cavity of destruction by means of medical bronkhoskopiya and aspiration washings of a cavity of abscess is made. An important component of preoperative preparation is the infusional therapy directed to completion of proteinaceous losses, electrolytic violations, reduction of purulent intoxication, correction of anemia and rheological changes.
The surgeries made concerning chronic abscess come down to a lung resection in various volumes. Lobectomy, a bilobektomiya or a pulmonektomiya is most often made. Carrying out a pnevmotomiya is inexpedient as does not allow to liquidate a cavity and surrounding changes. The lethality after operation makes 3-10%. Expeditious treatment is contraindicated at low functional reserves of an organism (heavy respiratory and heart failure), a widespread amiloidoz of internals. In these cases life expectancy of patients with chronic abscess of a lung is small.
Prevention of chronic abscesses of lungs demands full treatment of sharp abscesses, observation of patients with residual cavities, timely extraction of foreign matters of bronchial tubes and pulmonary fabric, refusal of addictions.