Abscess of the lung: symptoms, diagnosis and treatment
Abscess of the lung is purulent-destructive( the formation of pus occurs with the destruction of lung tissue) process.
It can be formed both in acute and chronic form, and the reasons for its development can be more than abound.
Usually, an abscess can become a consequence of pneumonia, especially when the drainage in the corresponding bronchi is broken, which are adjacent to the outbreak. This development mechanism is central to the development of the abscess.
Also important is the blockage of the bronchus lumen due to mucus or foreign body, mucus edema may also develop, due to which atelectasis( saccule protrusions) is formed.
Atelectasis is simply an ideal place for developing an abscess, because the microbial flora meets ideal conditions for growth and reproduction. The flow of an abscess of this type passes with a special severity.
Often the pathology develops in males, the age of which is from 20 to 50 years. The disease also affects the right lung more often( it is more than the left one).Localization can be anywhere, but often it's the top departments.
Clinical symptoms of lung abscess have a clear dependence on the development phase. So in the period of formation purulent infiltration and melting of lung tissue is, but there is no communication with the bronchus. Symptomatics resembles pneumonia with severe course. The general condition is severe, the temperature is high, and cough.
If the finger is knocked on the abscess, the sound will be dulled, and the breath in this place is weakened. During respiration, the affected side reacts with pain, and if during this period to make an X-ray examination, a limited shadow with a different intensity and magnitude becomes visible.
In a period of 4 to 10 days, the symptoms of lung abscess increase, and only then breakthrough pus in the bronchus. This indicates the beginning of the second phase, characterized by the presence of a cough and the release of a large amount( 200 to 80 milliliters) of sputum, which has a fetid odor. If you look at it under a microscope, then it will contain a large amount of leukocytes, red blood cells, cellular detritus( destroyed tissue cells), bacteria and elastic fibers are also present.
If necrotic tissues predominate in the cavity, sputum becomes especially fetid, blood may be present( if the process affected the vessel).The contents of the cavity can be divided into three layers, in the lowest one - pus and disintegrated tissues, the second is a yellowish transparent liquid, and the top is frothy. The abscess can break, and the contents will flow through the bronchus. Further, the clinic will depend on the degree of emptying the cavity, immunity, and tactics of treatment.
There is a category of population whose regeneration processes are slow. The cavity is cleared of pus not to the full extent, its decline is bad. In this case, a chronic abscess of the lung can not be avoided.
This state has its own clinic and methods of treatment. It should be noted that the breakthrough of acute abscess can occur not only in the bronchi, but also in the pleural cavity. Complication of such a breakthrough can be acute pneumothorax, which can "disguise" the present disease, subsequently it can cause empyema of the pleura( accumulation of pus in the pleural cavity).
In an attenuated person, in the presence of a particularly virulent( able to change) flora, and also with poor emptying of the abscess, the abscess can progress. Involve all new areas of the lung, the necrosis zone is constantly increasing, new areas of abscess formation are formed. The clinical picture is constantly deteriorating, the person is worried by chills, pouring perspiration, the general condition leaves much to be desired, the heart, kidneys, liver suffers. In this state, a person's death is possible.
Acute abscess can be mild, moderate or severe. An easy variant of the course of the disease flows with a single cavity, as well as a not very pronounced reaction along the periphery in the X-ray image, there is a clear level of liquid. Such an abscess is formed during 8-10 days. When the process is emptied, a full recovery begins.
The average severity is characterized by the presence of an abscess with a single cavity, but it is surrounded by a significant area of the wall reaction. Formation of the abscess occurs slowly, against a background of prolonged pneumonia. After a breakthrough, the cavity is drained poorly, the temperature drop is unstable, often exacerbations occur. X-ray dynamics is slow, recovery is rare, often the abseus passes into a chronic course.
Heavy current causes severe intoxication, the work of the heart, liver, kidneys is disrupted. Pulmonary tissue is infiltrated, the cavity is not formed for a long time, and the temperature is characterized by high numbers. The amount of sputum that a person gives out is constantly growing. Against the background of massive infiltration, many small cavities are formed. Treatment is required only surgical.
Diagnosis of lung abscess before its breakout presents certain difficulties, because it is not difficult to confuse it with pneumonia.
A person is disturbed by a cough with sputum, chest pain, which is intensified when involved in the pleura process. The temperature is accompanied by fluctuations in the morning and evening hours and accompanied by profuse sweating.
The blood test is also changing, in which the leukocyte count, neutrophil count increases and the erythrocyte sedimentation rate( ESR) is accelerated. Also a person should be examined by a doctor who can make an accurate diagnosis after taking an X-ray.
When a breakthrough occurred, the task is facilitated, because a person can sputum "full mouth", especially when changing the position of the body( for example, if you lie on your side).On an x-ray, everything looks like a cavity with a liquid level and a layer of gas above it.
It is by no means necessary to engage in self-medication of this condition, because complications may occur, it is worthwhile to see a doctor who will establish the correct diagnosis and prescribe adequate treatment. Depending on the phase, the tactician's tactics can be operational or conservative.
For the treatment of lung abscess, antibiotics of a wide spectrum of action are applied, as well as high-calorie nutrition. Antibiotics can be injected into the abscess cavity with bronchoscopy( the method allows to examine the bronchial tree from the inside).Also, anti-inflammatory, detoxifying, immunostimulating therapy is prescribed.
If the process has passed to the chronic stage or its severe course is observed, surgical treatment of the abscess of the lung should not be postponed to a "long box".The surgeon can remove part of the lung( lobectomy) or all of the lung( pulmectomy or pnemectomy).
Surgical intervention is very rare, only if complications occur.
It can be formed both in acute and chronic form, and the reasons for its development can be more than abound.
Usually, an abscess can become a consequence of pneumonia, especially when the drainage in the corresponding bronchi is broken, which are adjacent to the outbreak. This development mechanism is central to the development of the abscess.
Also important is the blockage of the bronchus lumen due to mucus or foreign body, mucus edema may also develop, due to which atelectasis( saccule protrusions) is formed.
Atelectasis is simply an ideal place for developing an abscess, because the microbial flora meets ideal conditions for growth and reproduction. The flow of an abscess of this type passes with a special severity.
Symptoms of lung abscess
Often the pathology develops in males, the age of which is from 20 to 50 years. The disease also affects the right lung more often( it is more than the left one).Localization can be anywhere, but often it's the top departments.
Clinical symptoms of lung abscess have a clear dependence on the development phase. So in the period of formation purulent infiltration and melting of lung tissue is, but there is no communication with the bronchus. Symptomatics resembles pneumonia with severe course. The general condition is severe, the temperature is high, and cough.
If the finger is knocked on the abscess, the sound will be dulled, and the breath in this place is weakened. During respiration, the affected side reacts with pain, and if during this period to make an X-ray examination, a limited shadow with a different intensity and magnitude becomes visible.
In a period of 4 to 10 days, the symptoms of lung abscess increase, and only then breakthrough pus in the bronchus. This indicates the beginning of the second phase, characterized by the presence of a cough and the release of a large amount( 200 to 80 milliliters) of sputum, which has a fetid odor. If you look at it under a microscope, then it will contain a large amount of leukocytes, red blood cells, cellular detritus( destroyed tissue cells), bacteria and elastic fibers are also present.
If necrotic tissues predominate in the cavity, sputum becomes especially fetid, blood may be present( if the process affected the vessel).The contents of the cavity can be divided into three layers, in the lowest one - pus and disintegrated tissues, the second is a yellowish transparent liquid, and the top is frothy. The abscess can break, and the contents will flow through the bronchus. Further, the clinic will depend on the degree of emptying the cavity, immunity, and tactics of treatment.
There is a category of population whose regeneration processes are slow. The cavity is cleared of pus not to the full extent, its decline is bad. In this case, a chronic abscess of the lung can not be avoided.
This state has its own clinic and methods of treatment. It should be noted that the breakthrough of acute abscess can occur not only in the bronchi, but also in the pleural cavity. Complication of such a breakthrough can be acute pneumothorax, which can "disguise" the present disease, subsequently it can cause empyema of the pleura( accumulation of pus in the pleural cavity).
In an attenuated person, in the presence of a particularly virulent( able to change) flora, and also with poor emptying of the abscess, the abscess can progress. Involve all new areas of the lung, the necrosis zone is constantly increasing, new areas of abscess formation are formed. The clinical picture is constantly deteriorating, the person is worried by chills, pouring perspiration, the general condition leaves much to be desired, the heart, kidneys, liver suffers. In this state, a person's death is possible.
Acute abscess can be mild, moderate or severe. An easy variant of the course of the disease flows with a single cavity, as well as a not very pronounced reaction along the periphery in the X-ray image, there is a clear level of liquid. Such an abscess is formed during 8-10 days. When the process is emptied, a full recovery begins.
The average severity is characterized by the presence of an abscess with a single cavity, but it is surrounded by a significant area of the wall reaction. Formation of the abscess occurs slowly, against a background of prolonged pneumonia. After a breakthrough, the cavity is drained poorly, the temperature drop is unstable, often exacerbations occur. X-ray dynamics is slow, recovery is rare, often the abseus passes into a chronic course.
Heavy current causes severe intoxication, the work of the heart, liver, kidneys is disrupted. Pulmonary tissue is infiltrated, the cavity is not formed for a long time, and the temperature is characterized by high numbers. The amount of sputum that a person gives out is constantly growing. Against the background of massive infiltration, many small cavities are formed. Treatment is required only surgical.
Diagnosis of lung abscess
Diagnosis of lung abscess before its breakout presents certain difficulties, because it is not difficult to confuse it with pneumonia.
A person is disturbed by a cough with sputum, chest pain, which is intensified when involved in the pleura process. The temperature is accompanied by fluctuations in the morning and evening hours and accompanied by profuse sweating.
The blood test is also changing, in which the leukocyte count, neutrophil count increases and the erythrocyte sedimentation rate( ESR) is accelerated. Also a person should be examined by a doctor who can make an accurate diagnosis after taking an X-ray.
When a breakthrough occurred, the task is facilitated, because a person can sputum "full mouth", especially when changing the position of the body( for example, if you lie on your side).On an x-ray, everything looks like a cavity with a liquid level and a layer of gas above it.
Treatment of abscess of lung
It is by no means necessary to engage in self-medication of this condition, because complications may occur, it is worthwhile to see a doctor who will establish the correct diagnosis and prescribe adequate treatment. Depending on the phase, the tactician's tactics can be operational or conservative.
For the treatment of lung abscess, antibiotics of a wide spectrum of action are applied, as well as high-calorie nutrition. Antibiotics can be injected into the abscess cavity with bronchoscopy( the method allows to examine the bronchial tree from the inside).Also, anti-inflammatory, detoxifying, immunostimulating therapy is prescribed.
If the process has passed to the chronic stage or its severe course is observed, surgical treatment of the abscess of the lung should not be postponed to a "long box".The surgeon can remove part of the lung( lobectomy) or all of the lung( pulmectomy or pnemectomy).
The results of the conservative treatment of lung abscess can be the following: rehabilitation - 70%, the beginning of the chronic process - 20%.Indications for surgery appear in 5% of patients, the lethal outcome is also at the level of 5%.
Surgical intervention is very rare, only if complications occur.