Abscess of a lung is a nonspecific inflammation of pulmonary fabric from which fusion with education results is purulent - necrotic cavities. During formation of an abscess fever, torakalgiya, dry cough, intoxication is noted; during opening of abscess - cough with a plentiful otkhozhdeniye of a purulent phlegm. The diagnosis is exposed on the basis of set of clinical, laboratory data, a radiological picture. Treatment means performing massive antimicrobic therapy, infusion-transfusion therapy, a series of sanatsionny bronkhoskopiya. Surgical tactics can include drainage of abscess or a resection of lungs.
Abscess of a lung enters into group of "infectious destructions of lungs", or "destructive pneumonites". Among all nagnoitelny processes in lungs 25-40% fall to the share of abscess. Abscesses of pulmonary fabric 3-4 times more often are registered at men. A typical portrait of the patient - the man of middle age (40-50 years), socially uncomfortable, abusing alcohol, with a long experience of the smoker. More than a half of abscesses is formed in the top share of the right lung. Relevance of a perspective in modern pulmonology is caused by the high frequency of unsatisfactory outcomes.
Activators get into a lung cavity in the bronkhogenny way. Golden staphylococcus, gramotritsatelny aerobic bacteria and nesporoobrazuyushchy anaerobic microorganisms are the most common cause of abscess of lungs. In the presence of inflammatory processes the probability of infection of pulmonary fabric increases in an oral cavity and a nasopharynx (periodontosis, tonsillitis, gingivit, etc.). Aspiration by emetic masses, for example, in unconsciousness or in alcohol intoxication, aspiration by foreign matters can become the reason of abscess of lungs too.
Options of infection with a hematogenic way when the infection gets to pulmonary capillaries at bacteremia (sepsis) meet seldom. Secondary bronkhogenny infection is possible at a lung heart attack which happens because of an embolism of one of branches of a pulmonary artery. During military operations and acts of terrorism abscess of a lung can be formed owing to direct injury or wound of a thorax.
People with diseases at which the probability of a purulent inflammation, for example patients with diabetes increases enter into risk group. At a bronkhoektatichesky disease there is a probability of aspiration by the infected phlegm. At chronic alcoholism aspiration by the emetic masses which chemical hostile environment can also provoke lung abscess is possible.
The initial stage is characterized by limited inflammatory infiltration of pulmonary fabric. Then there is a purulent fusion of infiltrate from the center to the periphery therefore there is a cavity. Gradually infiltration around a cavity disappears, and the cavity is covered by granulyatsionny fabric, in case of the favorable course of abscess of a lung there is a cavity obliteration to formation of the site of a pneumosclerosis. If as a result of infectious process the cavity with fibrous walls is formed, then in it purulent process can samopodderzhivatsya vaguely long period of time (chronic abscess of a lung).
Abscesses of lungs classify by an etiology depending on the activator on pnevmokokkovy, staphylococcal, kollibatsillyarny, anaerobic and so forth. Pathogenetic classification is based on how there was infection (bronkhogenny, hematogenic, traumatic and other ways). On an arrangement in pulmonary fabric abscesses happen central and peripheral, besides they can be single and multiple, settle down in one lung or to be bilateral. Some authors hold the opinion that gangrene of a lung is the following stage of abscess. By origin allocate:
- Primary abscesses. Develop in the absence of background pathology at earlier healthy faces.
- Secondary abscesses. Are formed at persons with immunosupression (The HIV-positive people who transferred organ transplantation).
Symptoms of abscess of lungs
The disease proceeds during two periods: period of formation of abscess and period of opening of a purulent cavity. During formation of a purulent cavity the pains in a thorax amplifying at breath and cough, fever, time of gektichesky type, dry cough, short wind, rise in temperature are noted. But in certain cases clinical manifestations can be poorly expressed, for example, at alcoholism of pains is practically not observed, and temperature seldom rises to subfebrilny. With development of a disease intoxication symptoms accrue: headache, appetite loss, nausea, general weakness. The first period of abscess of a lung on average proceeds 7-10 days, but perhaps long current up to 2-3 weeks or on the contrary, development of a purulent cavity has prompt character and then in 2-3 days the second period of a disease begins.
During the second period of abscess of a lung there is an opening of a cavity and outflow of purulent contents through a bronchial tube. Suddenly, against the background of fever, cough becomes damp, and the expectoration of a phlegm occurs "a full mouth". Per day about 1 liter and more purulent phlegm which quantity depends on cavity volume departs. Symptoms of fever and intoxication after an otkhozhdeniye of a phlegm begin to decrease, the health of the patient improves, blood tests also confirm fading of infectious process. But clear split between the periods is observed not always if the draining bronchial tube of small diameter, then the otkhozhdeniye of a phlegm can be moderate.
If putrefactive microflora, then because of a fetid smell of a phlegm is the reason of abscess of a lung, stay of the patient in the general chamber is impossible. After long standing in capacity there is a stratification of a phlegm: the lower dense and dense bed of grayish color with a kroshkovidny fabric detrit, the center consists of a liquid purulent phlegm and contains a large amount of saliva, and in the top layers there is a foamy serous liquid.
If the pleural cavity and a pleura is involved in process, then abscess is complicated by purulent pleurisy and piopnevmotoraksy, at purulent fusion of walls of vessels there is pulmonary bleeding. Spread of an infection, with damage of a healthy lung and with formation of multiple abscesses, and in case of spread of an infection in the hematogenic way – formation of abscesses in other bodies and fabrics, that is generalization of an infection and bakteriyemichesky shock is also possible. Approximately in 20% of cases sharp purulent process is transformed to chronic.
At visual survey, a part of a thorax with the affected lung lags behind during breath, or if abscess of lungs has bilateral character, the movement of a thorax is asymmetric. In blood pronounced , stab shift of a leykotsitarny formula, toxic granularity of neutrophils, the increased SOE level. In the second phase of abscess of a lung blood tests gradually improve. If process hronizirutsya, then in the SOE level increases, but remains rather stable, there are also symptoms of anemia. Biochemical indicators of blood change – the amount of sialovy acids, fibrin, a seromukoid, gaptoglobin and α2-and at - globulins increases; tells decrease in albumine in blood about synchronization of process. In the general analysis of urine – the tsilindruriya, a mikrogematuriya and an albuminuriya, degree of expressiveness of changes depends on weight of a course of abscess of a lung.
Carry out the general analysis of a phlegm on presence of elastichesky fibers, atypical cages, mikobakteriya of tuberculosis, a gematoidin and fatty acids. The bacterioscopy with the subsequent bakposev of a phlegm is carried out for identification of the activator and definition of its sensitivity to antibacterial medicines. The X-ray analysis of lungs is the most reliable research for diagnosis, and also for differentiation of abscess from other bronchopulmonary diseases. In difficult diagnostic cases carry out KT or MPT of lungs. The ECG, the spirography and a bronkhoskopiya are appointed for confirmation or an exception of complications of abscess of a lung. At suspicion on development of pleurisy the pleural puncture is carried out.
Treatment of abscess of a lung
Weight of a course of a disease defines tactics of its therapy. Perhaps both surgical, and conservative treatment. Anyway it is carried out in a hospital, in the conditions of specialized office of pulmonology. Conservative therapy includes observance of a bed rest, giving to the patient of the draining situation several times a day for 10-30 minutes for improvement of outflow of a phlegm. Antibacterial therapy is appointed immediately, after definition of sensitivity of microorganisms antibiotic treatment correction is possible. For reactivation of immune system carry out an autogemotransfuziya and transfusion of components of blood. Antistafilakokkovy and gamma globulin is appointed according to indications.
If natural drainage is not enough, then carry out a bronkhoskopiya with active aspiration of cavities and with washing by their solutions of anti-septic tanks (a bronkhoalveolyarny unleavened wheat cake). Perhaps also introduction of antibiotics directly in a lung abscess cavity. If abscess is located peripheral and has the big size, then resort to a transthoracic puncture. When conservative treatment of abscess of a lung is ineffective, and also in cases of complications the lung resection is shown.
Forecast and prevention
The favorable course of abscess of a lung goes with a gradual rassasyvaniye of infiltration around a purulent cavity; the cavity loses the correct roundish outlines and ceases to be defined. If process does not accept the long or complicated character, then recovery occurs in 6-8 weeks. The lethality at abscess of a lung is rather high and today makes 5-10%. There is no specific prevention of abscess of a lung. Nonspecific prevention is timely treatment of pneumonia and bronchitis, sanitation of the centers of a chronic infection and the prevention of aspiration of airways. Also important aspect in decrease in incidence is fight against alcoholism.