Purulent discharge from the lungs in cancer. Lung abscess: causes, symptoms, principles of treatment. Lymphatic route of infection

In this article, we will talk with you about what to do and for what reason pus appeared in the lungs. Treatment of pus in the lungs is quite difficult and intense. However, I believe that it is much worse to endure the symptoms of pus in the lungs: pain and feel severe discomfort when the pus in your body, and in your lungs in particular, spreads.

First of all, I would like to draw your attention to the fact that the treatment and prevention of pus in the lungs is a serious and rather unpleasant process. Purulent diseases of the lungs are large group pathological processes that develop in the lung tissue. Lung diseases, especially purulent ones, are very diverse in terms of causes and symptoms. There is no specific microflora as the cause of pus in the lungs.

Treatment of pus in the lungs

Speaking about the treatment of pus that has accumulated in the lungs, we note that it takes place in several main directions. It is impossible to single out the main direction in the treatment of pus in the lungs, because each of them is of great importance for the successful disposal of the problem. I'm talking about the following areas:

Measures that are aimed at maintaining and restoring the general condition, as well as correcting homeostasis that has been disturbed.

Measures that correct the immunological response.

Measures that are aimed at suppressing microorganisms that are the causative agents of the infectious process.

Measures that provide optimal drainage of foci of destruction in the lung.

Radical surgical treatment pus in the lungs.

Finally, I want to say about the need to carefully take care of your body, strengthen your immune system, and also make sure that the infection does not enter the body. If it is, of course, possible to follow.

Symptoms of pus in the lungs

Diseases due to which pus forms in the lungs, the treatment of which is quite difficult, most often occur due to the development of non-clostridial bacteria in the lungs.

In medicine, there are several lung diseases that are accompanied by the appearance of pus:

purulent abscess;
gangrene of the lung.

According to the presence of complications, 2 types of diseases are also distinguished: complicated and uncomplicated. What can complicate these diseases? First, pleural empyema. Also, you may experience heavy bleeding or sepsis.

As for abscesses, they can be peripheral, single, multiple, bilateral and unilateral in their localization.

Now you know the symptoms of pus in the lungs, as well as how to treat it.

At its core, this is a secondary disease that occurs as a complication after suffering a croupous or influenza type of pneumonia.

Etiology and types of disease

There are two types of purulent pleurisy:

Parapneumonic pleurisy of the lungs is considered a kind of complication of pneumonia that occurs during the period of its progression. The second type begins to develop after the pneumonia has ended. It is more common in medicine. In addition, their appearance almost always provokes the development of serous-purulent or purulent exudation.

Most often, the appearance of purulent pleurisy is due to the presence of staphylococci, streptococci, Pseudomonas aeruginosa or Escherichia coli. Often, in the process of analyzing crops of the contents of the pleura, the presence of pneumococcus, Proteus, Klebsiella and yeast is determined. It is currently very common in researched content to have anaerobic bacteria. They are more characteristic of putrefactive empyema, which complicates the course of pulmonary gangrene.

The data of domestic and foreign studies indicate that the number of staphylococcal diseases is rapidly increasing. At the same time, there is a progressive increase in the percentage of strains characterized by a high degree of resistance to antibiotics.

There has also been a significant increase in discharges containing penicillin-resistant bacteria. At the same time, the number of microorganism species present in the secretions is constantly increasing in the dynamics of the treatment of pneumonia with antibiotics.

Symptoms of the disease

Patients who have been diagnosed with purulent pleurisy most often complain of the following signs of the disease:

the presence of pain and a feeling of heaviness in the lateral region, cough;
difficulty breathing and inability to take full breaths;
the appearance of shortness of breath;
a significant increase in body temperature;
appearance of weakness.

In the early stages of the onset of the disease, symptoms such as stabbing pain in the chest area. But with the expansion of the area of influence of inflammation and with the formation of exudate, they become less intense, a feeling of heaviness appears in the side.

Over time, shortness of breath becomes more pronounced. In many cases, a dry cough is present. If there is a development of secondary pleurisy, which occurs due to pneumonia or lung abscess, cough is accompanied by sputum. It has the appearance of mucus or purulent consistency.

With the development along with pleurisy of another disease, a change in the characteristic features of cough is observed. It becomes more intense and painful, often begins to occur at night. In some cases, it can have the character of seizures and is greatly enhanced when a person lies on the diseased side of the body.

Abscess rupture process

What will happen if the patient is not provided with timely medical care? Shortness of breath becomes pronounced. Strengthening it is observed, as in the case of cough, when the patient lies on his side. Therefore, the patient always has to take the same position of the body in order to avoid discomfort, to facilitate breathing and reduce pain in the chest.

Body temperature rises to a maximum and is characterized by a stable or hectic character. The pulse is beats per minute. This is affected not only by intoxication with purulent masses, but also by a shift in the cardiac and vascular position in opposite side from accumulated exudate.

When a lung abscess ruptures, pus and air masses enter the pleural cavity. This provokes the onset of pleural shock. Intense cough, which practically does not stop, is the most basic precursor of a purulent impulse.

The person fails to take a deep breath, the face gradually turns pale, the skin appears cold sweat. At the same time, the heart rate increases and there is a significant decrease blood pressure. The sensation of pain provokes the occurrence of shallow, rapid breathing. There is an appearance of acrocyanosis and an increase in shortness of breath.

The reasons for this - in the irritation of the pleura. It is the source of the appearance of pain, air pressure and purulent masses of the lung, changes in the position of organs and disruption of the heart.

After they subside acute manifestations disease and the patient is taken out of shock, the development of intoxication begins. She is more dangerous form than with one of the types of pleural empyema.

If pleurisy is started, scarring, adhesions form, bronchiectasis develops, inflammation becomes chronic, and exacerbations occur from time to time.

Ways to treat the disease

The main task of the treatment of purulent pleurisy is to eliminate the infection and symptoms of emerging intoxication. In addition, you need to restore normal work diseased organs.

First of all, you need to eliminate the purulent focus and straighten the lung after that. Only after the pleura sheets grow together and obliteration of the focus cavity occurs, it will be possible to talk about recovery. The most important thing is to start treatment on time, which prevents the appearance of moorings in the pleura and the transition of the disease to a chronic form.

Treatment of the patient consists in pumping out the exudate. The procedure is accompanied by the introduction of penicillin into the cavity intramuscularly. If indicated, transfuse plasma or red blood cells.

Difficult cases require surgical treatment, during which the rib is resected.

Possible consequences

Pleurisy of the lungs is an extremely serious disease. If it has been started or not completely cured, there is Great chance the occurrence of complications that are dangerous to human health. This may be an adhesion that has appeared, a bronchopleural fistula, impaired blood circulation, which provoked exudate pressure on the vessels. In addition, there is a threat of the emergence and development of kidney disease.

by the most dangerous consequence This disease is pleural empyema. The essence of this pathological process is that pus accumulates in the lungs and under the influence of this a free cavity is formed. A kind of "pocket" is formed. After that, the pleura is scarred and completely immures one of the lungs.

Another serious consequence of purulent pleurisy is the appearance of amyloidosis of parenchymal organs. Almost ½ of all cases of occurrence this complication have had fatal outcome. The development of amyloidosis is typical for people with a weakened body, the elderly and children.

A small amount of exudate can be absorbed without intervention. After the underlying disease has been eliminated, exudation stops after a week. If the liquid was removed, then sometimes there may be stubborn current, and the effusion again accumulates in the pleural cavity. This is especially true for the infectious type of pleurisy. If the cause of the disease is an oncological nature, then the disease always progresses and the outcome in almost 100% of cases is not favorable. Purulent pleurisy has the same type of course of the disease.

Patients with a history of this disease are under long-term observation in the dispensary. In addition, among the recommendations of doctors in the first place is the rejection of fortified and high-calorie diets, the prevention of colds and hypothermia, limiting work in especially harmful conditions associated with chemicals.

The essence of the prevention of purulent pleurisy is the timely and high-quality treatment of those diseases that provoke its appearance and development.

Be sure to increase the resistance of your body to various infections.

Copying site materials is possible without prior approval in case of installing an active indexed link to our site.

JMedic.ru

Purulent pleurisy, which can also be called "pleural empyema" or "pyothorax", is a variant of exudative pleurisy, in which the effusion is represented by purulent masses. Pus, in turn, is called effusion, which in large quantities contains fragments of dead white blood cells - leukocytes and pathogenic microorganisms. It has a thick consistency and a white-yellow color.

In the figure, the diagram of the pleural cavity is normal and with purulent pleurisy.

Acute purulent pleurisy is characterized by the rapid accumulation of pus in the pleural cavity, its effect on the body - intoxication, as well as the development of respiratory failure, which can also be combined with signs of heart failure.

Origin of pleural empyema

It is customary to single out purulent pleurisy as an independent disease, because the main symptoms that form the clinical picture of the disease and its possible consequences differ from those in other variants of exudative pleurisy. At the same time, the treatment of patients, as a rule, requires active efforts at the local level and must be accompanied by their stay in a surgical hospital.

Origin this species pleurisy may result from:

Complicated pneumonia
Purulent-destructive diseases of the lungs, the most common of which should be considered abscess and gangrene of the lung.
Injuries and surgical interventions on the lungs
Acute inflammatory processes in the abdominal cavity: for example, subdiaphragmatic abscess
Spread through the bloodstream of infection from a distant purulent focus: for example, in cases of osteomyelitis - lesions of the vertebral bodies. In this case, an abscess of the lung is again formed. An abscess, in turn, leads to pleural empyema.

The figure shows the upper lobe of the left lung, in which an abscess has formed. At the same time, the pathological process has already melted the lung tissue and is ready to move into pleural cavity.

Nowadays, an abscess in the lungs gives an incidence of pleural empyema of about 10%, while pneumonia is 5%. But in patients with lung gangrene, this frequency is about 97%. This is due to the fact that gangrene is a very formidable condition, which is characterized by the death of tissues in contact with the external environment. It is caused by a special group of pathogenic microorganisms, which, as a rule, are distinguished by particularly pronounced viability and pathogenic properties.

It is worth talking about abscesses in a little more detail. Most often, a lung abscess is the result of a general decrease in immunity, or getting into Airways foreign body. Often, an abscess is formed as a result of aspiration, that is, inhalation by the patient of vomit, food particles, or other foreign particles. Usually the abscess is surrounded by a dense capsule.

However, over time, pus can melt its wall: then the abscess breaks through, and nearby tissues melt. It was at the moment of the breakthrough of the abscess and the spread of inflammation along lung tissue to the visceral pleural sheet, pleural empyema may form. Therefore, it is important to diagnose an abscess in a timely manner and prevent its complications.

It is important to remember that purulent inflammation in the lining of the lungs can be the consequences of a puncture of the pleural cavity or subclavian vein, if these manipulations are performed roughly and illiterately, in connection with which trauma to the pleural sheets occurs. However, nowadays such a complication is quite rare.

Microorganisms - causative agents purulent inflammation The lining of the lungs is most commonly affected by the following bacteria:

Staphylococcus aureus or Staphylococcus aureus.

Micrograph of Staphylococcus aureus. The bacterium has spherical shape and is arranged in the form of grapes.

Micrograph of Streptococcus pyogenes. The bacterium has a spherical shape and is arranged in the form of chains.

Micrograph of Escherichia coli. The bacterium is rod-shaped. Arranged in groups.

Micrograph of Haemophilus influenzae. It has a stick shape. It is more scattered. Compared to E. coli.

Quite often, the above microorganisms are in association with anaerobes, bacteroids, fusobacteria or prevotella. Anaerobes are called microorganisms that do not need oxygen for adequate life. In patients who long time are on artificial lung ventilation, in general anaerobes can be the only causative agents of a purulent pathological process in the cavity of the lung membrane.

Clinical picture of pleural empyema

In the first few tens of hours from the onset of the disease, signs of purulent pleurisy are usually masked. The patient mainly complains of symptoms characteristic of most pathological processes in the lungs: chest pain, weakness, lethargy, slight shortness of breath, fever.

By the third day of illness, the patient's condition usually deteriorates rapidly and significantly. There are severe pains in the chest, which increase or occur when breathing and coughing: the so-called "pleural pains". Body temperature rises to degrees. In this case, fluctuations in body temperature per day can reach 2 degrees. The patient experiences shaking chills, an increase in shortness of breath, becomes lethargic and gradually loses interest in reality, his face may be haggard, his eyes sunken, his features sharpened: all these are signs of an intoxication syndrome, that is, the harmful effect of accumulated pus on the patient's body. Upon examination, symptoms such as rapid breathing, sweating, difficulty in inhaling and diffuse cyanosis, that is, cyanosis of the patient's skin, immediately attract the doctor's attention.

Accumulating, pus tends to spread: it simply melts nearby structures and passes to the soft tissues of the chest wall. This may lead to the formation of a fistula, that is, an anastomosis between the pleural cavity and the external environment.

If a fistula is formed between the cavity of the lung membrane and the bronchus, then spontaneous removal of purulent exudate from the pleural cavity occurs. In this case, the patient develops or significantly intensifies cough, separates a large number of purulent sputum, often containing an admixture of blood in its composition. Moreover, the cough with the separation of purulent masses becomes stronger in the position of the patient on a healthy side: the so-called "drainage position".

A blood test reveals an increase in white blood cells - leukocytes: up to a thousand per 1 microliter at a rate of up to nine thousand. The erythrocyte sedimentation rate increases domm/h, which is 4 times higher than the norm. Leukemoid reactions are possible. This means that the number of young and young forms of leukocytes significantly increases in the blood formula.

Confirmation of the diagnosis of purulent pleurisy usually occurs during the study of the actual contents of the cavity of the membrane of the lungs, which is obtained by puncture. Purulent exudate is usually cloudy and viscous. It may have different colors. It depends mainly on the causative agent of the pathological process and its properties. If the causative agent was pneumococcus or staphylococcus, then the pus will have a yellow tint, if streptococcus is grayish. If the pathogens are mostly anaerobic, then the pus will differ in a dirty gray color and a sharp, very unpleasant odor.

Later, a bacteriological study of purulent effusion is performed. It allows you to accurately determine the pathogens of the process and their individual sensitivity to antibacterial drugs. This makes it possible to prescribe adequate treatment.

Warning

If the prevalence of the purulent process in the lungs is quite large, and the treatment is insufficient and untimely, then acute inflammatory process in the pleura can turn into chronic pleural empyema. In this case, the pus in the pleural cavity eventually becomes surrounded by a kind of “bag”, the walls of which consist of dense and coarse connective tissue, poor in blood vessels. The reason for the transition of an acute inflammatory process in the lining of the lungs into a chronic one, as a rule, lies in the late detection and incomplete, “poor-quality” drainage of pleural empyema. A similar outcome is also an obstacle to the complete expansion of lung tissue, previously compressed purulent exudate.

Often, after the delimitation of the process that has become chronic, there is a complete replacement inflammatory focus connective tissue. This condition is called fibrothorax.

bright outward sign fibrothorax is a visible reduction in the affected half chest and its lag in movement during breathing.

Necessary therapeutic measures

If the diagnosis of purulent pleurisy is confirmed in a patient, it is urgent to prescribe adequate treatment. This will avoid the transition of acute purulent inflammation into a chronic form and other complications, such as increasing respiratory failure, for example.

The patient should be given antibiotic therapy. The choice of a specific drug should be dictated by the results of a bacteriological study obtained during a puncture of the pleural effusion.

In addition, detoxification therapy should be carried out, aimed at reducing harmful effects pathogen microorganism and the exudate itself on the patient's body. It consists in the introduction into the patient's body intravenously of solutions that improve the properties of blood and contribute to accelerated work kidneys as a filter, that is, the accelerated removal of harmful waste products of the pathogen bacteria from the patient's body.

In addition to treatment aimed at the patient's body as a whole, it is important to conduct active and regular local therapy. The latter is to ensure regular pleural punctures, which will allow the evacuation of exudate from the pleural cavity. The pleural cavity is washed antiseptic solutions, a drainage tube is inserted into it, through which the newly formed exudate departs, and drugs are introduced that accelerate tissue healing, and solutions for washing the pleural cavity.

Sometimes the drainage tube is connected to a special pump, which facilitates the work of medical personnel.

Causes of purulent pleurisy, characteristic symptoms, possible consequences and methods of treatment

The most complex and dangerous pathology of the lungs is pleurisy, and people of any gender fall into the risk group. With the progression of such a disease, an inflammatory process develops on the outer surface of the lung tissue, and pus accumulates inside the organ.

Acute purulent pleurisy causes an increase in body temperature and constant shortness of breath, and the patient is in an extremely serious condition.

The reasons for the development of such a pathology may be different, and in the absence effective therapy death is possible.

Causes of development and forms of the disease

Experts say that pleurisy is not independent disease. Mostly this disease develops as a result of the progression various ailments in other organs.

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All the causes that provoke pleurisy of the lungs are conditionally divided into:

Medical practice shows that the following pathologies can cause infectious pleurisy:

the appearance of problems with the functioning of the gastrointestinal tract;
diabetes;
chronic pathologies of the lungs;
alcoholism.

Non-infectious causes are various malignant tumors, and their place of localization becomes outer surface lungs. In addition, various injuries and injuries of the connective tissue can cause pleurisy of the lung tissue.

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Specialists distinguish several forms of pleurisy of the lungs, taking into account clinical picture. The dry form of the disease is considered initial stage disease development. For this form of pathology, damage to the circulatory system is characteristic, and infectious pathogens are not detected in the lung cavity.

The dry form of the disease is accompanied by an increase in vascular permeability under the influence of anti-inflammatory components. In addition, the patient has leakage of liquid plasma, and the result of this is the appearance of fibrous filaments on the lung surface. Such pleurisy is characterized by a violation of the outflow of fluid, which causes strong friction of the pleural sheets. This results in the emergence of strong pain at the patient.

In the absence of timely effective therapy, the dry form of the disease passes to the next stage. There is an increase in the focus of inflammation and exudative disease develops.

At this stage of the development of the disease, the activity of enzymes is significantly reduced and a kind of cavity appears, where pus subsequently accumulates. The exudative form of pleurisy is accompanied by a significant increase in pleural fluid, and under its influence, the volume of the lung is significantly reduced.

When the disease progresses to running stage, then the patient begins to suffer respiratory failure. There is a decrease in friction in the pleural sheets due to increased accumulation of fluid, which causes a decrease in pain.

The next stage in the development of the disease is purulent pleurisy or pleural empyema. This form of the disease is quite complex and poses a serious threat to the life of the patient. There is an accumulation of a large amount of pus in the serous membrane, and the general intoxication of the patient's body increases. Medical practice shows that empyema most often forms with the progression complex pathologies other organs or in patients with impaired functioning of the immune system.

With purulent pleurisy in acute form, there is a rise in body temperature and the appearance of shortness of breath, and general state The patient is diagnosed as extremely severe.

Symptoms of the disease

For purulent disease lungs are characterized by the appearance of the following symptoms:

the occurrence of acute pain and a feeling of heaviness;
breathing problems when it is impossible to take a deep breath;
there is a feeling of fullness in the side;
rise in body temperature;
severe cough and shortness of breath;
weakness of the body.

With purulent pleurisy, the patient complains of the appearance of strong painful sensations, but with the accumulation of pus, they begin to decrease. Purulent pleurisy is accompanied by the appearance of a dry cough, which especially worries the patient at night. In a situation where pleurisy develops as a complication after inflammation or abscess of the lungs, sputum with an admixture of pus begins to be detected.

A characteristic sign of a purulent lung disease is a rise in temperature of up to degrees. Fever may persist all the time or appear intermittently. The pulse reaches beats per minute and the cause of this condition is purulent intoxication of the body, as well as a displacement of the heart to one side.

This condition of the patient is considered severe and requires immediate medical attention. medical care. If effective therapy is not carried out, a breakthrough of pus into the pleural cavity is possible. During the development of the inflammatory process in the pleural cavity, not only pus accumulates, but also air. Such a pathological condition in medical practice is called "pyopneumothorax" and is accompanied by the appearance of severe shortness of breath and pain.

In the event that purulent pleurisy enters an advanced stage, the result is scarring of the tissue and the appearance of adhesions. In addition, bronchiectasis is diagnosed, and the inflammatory process becomes chronic with relapses.

Possible consequences and diagnosis

In the absence of effective therapy, pathology can pose a serious threat to the life of the patient. This is due to the fact that the progression of purulent pleurisy in the human body can result in the development of a lung abscess.

In the event that a breakthrough of a purulent pocket occurs, the infection spreads into the pleural cavity. The consequences of this pathological condition are pneumonia, cystic formations and gangrene.

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Breakthroughs of a pocket with pus in a patient are accompanied by a rise in temperature, as well as an increase in cough and increased heart rate. In addition, breathing quickens and when the abscess breaks, hypoxia begins to develop.

If pleurisy enters an advanced stage, then this causes a significant increase in the affected area of \u200b\u200bthe chest. The progression of pleurisy in the human body causes it general intoxication, and the content of a large amount of pus provokes the expansion of the intercostal space and respiratory arrest.

In the absence of effective therapy, the consequences of such an ailment can develop in the form of adhesions and pleural calcification. In addition, there may be a restriction of lung mobility and the development of acute heart failure.

Main and the only way detection of purulent pleurisy is x-ray examination chest. On the images obtained during the procedure, darkening of the lung tissue and oblique upper level liquids. The location of the fluid accumulation is determined by its quantitative volume.

Another effective method diagnosis of purulent pleurisy becomes a puncture of the lungs. The patient is taking fluid from the lungs, which is subsequently carefully studied. Thanks to this procedure, it is possible to diagnose the type of pathology and choose an effective course of treatment.

Features of the treatment of the disease

In the event that there are suspicions of purulent pleurisy, the patient is subject to mandatory hospitalization.

Treatment of such a pathology involves the solution of the following tasks:

stabilization of the patient's condition;
restoration of normal breathing;
elimination of the cause that provoked pleurisy.

In most cases, this pathology is infectious origin Therefore, drug therapy is carried out with the use of antibiotics and anti-inflammatory drugs.

In the fight against purulent pleurisy, the following antibacterial drugs are prescribed:

Taking antibiotics in the treatment of pleurisy helps to prevent the further spread of bacteria and cause their death.

It is possible to restore the water-electrolyte balance with the help of saline or glucose. Such drug treatment helps speed up renal filtration and quickly get rid of decay products.

Therapy of purulent pleurisy can be carried out using the following drugs:

diuretics help the body get rid of fluid and slow down the absorption of sodium and potassium;
non-steroidal anti-inflammatory drugs help get rid of severe pain;
glucocorticosteroids prevent the synthesis of anti-inflammatory components.

When dry pleurisy is detected, treatment involves compliance bed rest. In addition, it is prescribed to take drugs that have an antimicrobial, analgesic and anti-inflammatory effect on the body. Banks and warm compresses help speed up the healing process.

When diagnosing such a form of the disease as purulent exudative pleurisy, the patient is placed in the stationary conditions of a medical institution. Conservative therapy involves taking antitumor and anti-infective drugs on the body.

An important role in this form of the disease is the observance special diet with sufficient content of vitamins and proteins. Special meals involves the complete elimination of salt from the diet and the consumption of limited quantity liquids.

In the event that the appearance of an increased amount of fluid in the pleural cavity is diagnosed, then specialists make a decision to perform a puncture. To perform this procedure, a special needle is inserted to the side of the scapula, the pleura area. Thanks to the puncture, it is possible to remove excess fluid from the body, significantly reduce pressure in the lung cavity, and restore breathing. After the puncture, the patient is prescribed therapeutic exercises and physiotherapy.

Treatment of purulent pleurisy is carried out only in stationary conditions. Self-treatment diseases at home can pose a threat to the patient's life and cause the development of serious consequences.

The main task in the treatment of such a pathology is the prevention of the process of tissue destruction. A daily puncture is performed, the cavity is washed antiseptics, as well as drainage is superimposed.

With purulent pleurisy, drug treatment may not bring the desired result, so they resort to surgical intervention. During the operation, specialists remove dense scars of the pleura or its parietal sheets, and this is determined by the degree of lung damage.

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– provide up-to-date and useful information about the diseases treated by an ENT doctor (otolaryngologist). The pages of our site contain information about the main symptoms of diseases of the ENT organs, as well as the methods of their therapy - both in medical institutions and at home. It should be noted that authors with a medical education are working on the articles of the project (you can see the editorial data on the page "About the site"), so the main task of the portal is to provide reliable information, which will allow you to detect the problem in a timely manner and seek qualified help in time.

Abscess of the lung - non-specific inflammatory disease the respiratory system, as a result of the progression of which a cavity with thin walls is formed in the lung, inside which purulent exudate is contained. This disease more often begins to develop if inadequate treatment of pneumonia has been carried out - melting is observed in the area of \u200b\u200bthe lung, followed by tissue necrosis.

Less commonly, a thin-walled cavity is formed after a small bronchus is blocked by an embolus. As a result, oxygen ceases to flow into this area, it subsides, and infectious agents easily penetrate into it. Against the background of all this, an abscess begins to form. In more rare clinical situations, a cavity with pus is formed as a result of the introduction of infection into the lung tissues by the hematogenous route (from the focus of inflammation, which is already present in the human body).

Etiology

Lung abscess is an infectious process. Its development is facilitated pathogenic bacteria or fungi. Usually the disease progresses due to the pathological activity of pneumococci, fungi. Microorganisms penetrate into the lung tissues through the bronchi or with the blood flow from the foci of inflammation.

Most often, a lung abscess develops:

as a complication of previously transferred pneumonia;
when it enters the airways of the contents of the stomach;
due to the overlap of the bronchus by an embolus;
due to . This is a serious illness of an infectious nature, which is characterized by the appearance of foci of purulent inflammation in the vital important organs human body.

Risk factors:

smoking;
use alcoholic beverages a lot;
hypothermia;
decrease in the reactivity of the body.

Forms

In medicine, several classifications of lung abscess are used, which are based on the causes of the pathological process, its location in the organ, the duration and nature of the course.

From location:

central lung abscess;
peripheral. In this case, the focus of inflammation is located closer to the periphery of the lung.

From the causes that provoked the progression of the disease:

primary. In this case, the main reason for the formation of the pathological focus is trauma to the sternum;
secondary.

From the duration of the course of the pathological process:

acute lung abscess. The duration of the progression of the pathological process is no more than 6 weeks. As a rule, this is followed by a period of recovery;
chronic lung abscess. The duration of the disease is more than 6 weeks. This disease is characterized by alternating periods of exacerbation and remission.

From the nature of the course of the disease:

light flow. The characteristic symptoms of a lung abscess (shortness of breath, cough) are not pronounced;
moderate. Symptoms are expressed moderately;
heavy. Symptoms of the disease are pronounced, it is also possible the development of dangerous complications.

Symptoms

The symptomatology of an abscess directly depends on what form of pathology (acute or chronic) has developed in a person. It should be noted that if a small pathological cavity with purulent exudate is formed on the periphery of the organ, then the characteristic symptoms of the pathology may not be observed, which greatly complicates the diagnosis. This leads to a chronic inflammatory process.

acute form

This disease has two clinical stages:

the period of formation of a thin-walled cavity with pus;
opening period.

During the formation of an abscess, the following symptoms are observed:

symptoms of severe intoxication are noted;
heat;
loss of appetite;
dyspnea;
headache;
the patient's condition is rapidly deteriorating;
cough;
pain different intensity in the chest.

The severity of the course of the pathology depends on the number and size of the formed abscesses, on the type of pathogen that caused their formation. The specified period lasts up to 10 days. But it is worth noting the fact that its course can be both rapid - up to 2-3 days, and slow - up to 2-3 weeks.

After this, the period of opening the abscess begins. It breaks through its shell, and pus begins to stand out through the airways. At this time, the patient's condition worsens greatly. The main symptom indicating this process is a wet and sudden cough, during which a large amount of purulent sputum is released. Clinicians characterize this condition as "sputum expectoration mouthful". Its volume can reach one liter.

As soon as the abscess breaks through, the patient's condition gradually begins to improve. Symptoms of intoxication decrease, temperature normalizes, appetite is restored. But it is worth noting that shortness of breath, weakness and pain in the sternum persist. The duration of the course of the disease directly depends on the state of drainage, as well as on the right therapy.

Chronic form

It is worth talking about the development of this form of the disease if acute process lasts over two months. Also contribute to the progression of pathology big sizes purulent formation, its localization in the lower part of the organ, as well as poor sputum discharge. In addition, it is worth highlighting the following reasons:

decrease in the reactivity of the body;
chronic pathologies;
improper treatment of acute lung abscess.

The main symptoms of this form of the disease:

dyspnea;
cough, during which there is a release of sputum with a fetid odor;
the period of deterioration of the state is replaced by a period of its stabilization;
weakness;
exhaustion;
increased sweating.

Diagnostics

When the first symptoms appear that indicate the progression of a lung abscess, you should immediately contact your doctor. medical institution for passing complete diagnosis and installations accurate diagnosis. The standard diagnostic program includes:

collection and analysis of complaints;
general examination of the patient;
. This method diagnostics is necessary, as it makes it possible to detect signs of inflammation in the body;
sputum analysis. With the help of this diagnostic method, it is possible to identify the true causative agent of the disease, as well as to determine its sensitivity to antibiotics;
chest x-ray - a method by which you can detect the location of formations with pus;
CT is the most informative diagnostic technique. Allows you to determine the location, as well as the size of the abscess;
fiberoptic bronchoscopy is a diagnostic method that makes it possible to examine the respiratory tract in detail and determine the presence of abnormal formations in them.

Only after receiving the results of the diagnosis, you can begin to treat a lung abscess.

Treatment

Drug therapy is based on the use of such drugs:

antibiotics;
mucolytics;
antiseptics;
expectorant drugs;
immunomodulators;
detoxification agents;
oxygen therapy.

Also during conservative treatment apply techniques that allow you to quickly remove purulent sputum from the respiratory tract:

postural drainage;
breathing exercises;
vibration chest massage;
sanitation bronchoscopy.

Surgical intervention is indicated if drug therapy has not had the desired effect. The following methods are applied:

puncture. The abscess is pierced with a special needle. The purulent contents are removed, the cavity is washed with antiseptic solutions, after which antibiotics are injected into it;
thoracocentesis and drainage of the abscess cavity;
removal of a certain part of the lung (lobe).

Complications

empyema of the lungs;
pyopneumothorax;
septicopyemia;
secondary bronchiectasis.

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Diseases with similar symptoms:

Inflammation of the lungs (officially pneumonia) is an inflammatory process in one or both respiratory organs, which usually has an infectious nature and is caused by various viruses, bacteria and fungi. In ancient times, this disease was considered one of the most dangerous, and although modern facilities treatment allows you to quickly and without consequences get rid of the infection, the disease has not lost its relevance. According to official figures, in our country every year about a million people suffer from pneumonia in one form or another.

Lung abscess most often develops against the background of infectious inflammatory diseases, acting as their complication. Without correct diagnosis and timely treatment pathology leads to serious consequences and even death.

Lung Abscess - What is it?

A lung abscess is a disease in which lung tissue becomes inflamed and necrotizing. As a result, cavities with purulent-necrotic contents are formed that occur due to infection. When there are several such foci in the lungs, they speak of necrotizing pneumonia or gangrene.

most common cause abscess are pathogens such as Staphylococcus aureus, aerobic gram-negative bacteria and anaerobic non-spore-forming microorganisms.

Microbes penetrate the lungs through the bronchi, and not only tonsillitis, pneumonia, bronchitis and other pathologies of the respiratory system, but also a disease of the oral cavity, for example: tonsillitis, periodontal disease, gingivitis, caries, can serve as a trigger for infection and inflammation.

Less commonly, bacteria are introduced into the lung tissue with blood, that is, by the hematogenous route - from other inflamed organs - for example, with purulent appendicitis.

Disease pathogenesis

A lung abscess occurs in an airless area of tissue, which can be caused by different factors. In most cases, there is a combination of lung abscess and pneumonia. Also, purulent-necrotic cavities appear due to getting into foreign lung bodies with infection - a small fragment of a carious tooth, vomit.

Foreign bodies clog the smallest branches of the bronchi, and block the air flow in this place. Such a site is called atelectatic or airless, and an abscess is formed here.

An abscess in the lung tissue can appear with bronchiectasis, provoking factors are also elderly and advanced age, exhaustion and weakened immunity.

The pathogenesis of a lung abscess in a purulent cavity occurs as follows:

a limited area with an inflammatory infiltrate is formed in the lung tissue;
the abscess melts the tissues from the center to the edges, forming a cavity;
cavity lining occurs granulation tissue, and the infiltration around it disappears;
further obliteration of the cavity is observed and a site of pneumosclerosis is formed - in an acute course;
but if cavity walls are formed fibrous tissue, then suppuration can exist for a long time, and the lung abscess becomes chronic.

The risk group includes not only people with inflammatory diseases mouth, respiratory or other organs, but also people with such problems:

when the likelihood of developing purulent inflammation is increased significantly;
chronic alcoholism, in which there is a risk of vomit entering the bronchi;
bronchiectasis - aspiration of sputum containing infection is possible.

Classification

According to the duration of the course of the disease, lung abscess is acute and chronic. In the first case, ulcers appear within 3-6 weeks after the onset of the disease. In a chronic abscess, foci of necrosis form slowly.

By origin, the disease is classified into groups:

along the way of infection - hematogenous, traumatic, bronchogenic;
by pathogen - staphylococcal, pneumococcal and others.

By localization in tissues, the pathological process can be single or multiple, unilateral (abscess right lung or left) or bilateral, central and peripheral.

Signs and symptoms of a lung abscess

Signs of an acute lung abscess appear strong cough with the release of purulent sputum, often with blood impurities, pain is felt in the chest. In a chronic abscess, states of remission and exacerbation alternate.

During relapses, the above symptoms are observed. With the onset of remission, chest pains become less pronounced, but more sputum with pus is released, fatigue, sweating at night and coughing appear.

The symptoms are also different before and after the breakthrough of a lung abscess. Symptoms in the first case are as follows:

purulent contents accumulate in a certain area of the lung and the general condition becomes severe, fatigue is observed,
malaise;
loss of appetite;
sweating, especially strong at night;
dry painful cough and difficulty breathing;
temperature rise;
when listening, dry rales, shortened sounds are revealed above the place with an abscess;
phalanges are often thickened on the fingers;
on the x-ray lungs visible shadow of a rounded shape;
blood test shows increase in ESR and leukocytes.

Symptoms of a lung abscess after an abscess rupture:

profuse sputum production - up to a liter per day;
improvement general well-being and normalization of temperature;
breathing becomes easier, and when listening, the rales are wet;
reduced sweating, improved appetite;
the x-ray shows a rounded cavity and in the picture you can see the level of sputum in it.

The pathogenesis of an abscess and its breakthrough is sometimes accompanied by complications:

empyema of the pleura with a breakthrough of the abscess into the pleural cavity;
profuse bleeding with severe damage to the pulmonary vessels;
septicopyemia - the formation of purulent metastases in various organs;
gangrene of the lung;
pyopneumothorax, if the abscess communicates with the bronchus and breaks into the pleura;
impaired circulation and hypoxia with mediastinal displacement.

All these consequences are life-threatening and require immediate medical attention.

Diagnose the disease early stages before the breakthrough of the abscess is more difficult, in this regard, it is often confused with focal pneumonia. Therefore, the diagnosis of "lung abscess" is made on the basis of not only symptoms, but also other examination methods:

blood test;
Radiography;
Listening to the lungs with a stethoscope and phonendoscope (auscultation);
Percussion (tapping to assess emerging sounds).

Diagnosis is facilitated after opening the abscess, since during this period the disease is easily recognized by the appearance of abundant sputum and a cavity on an x-ray with a certain level of purulent content.

Pulmonary puncture for diagnosis is rarely resorted to, since there is a high risk of developing purulent pleurisy.
lung abscess, photo
In acute lung abscess, treatment is surgical or conservative, depending on the stage of development of the pathology. AT initial phase when an infiltrate has just appeared or no more than 1-1.5 months have passed since the formation of a cavity with purulent contents, they are prescribed antimicrobials a wide range actions.
It can be Streptomycin, Penicillin, Biomycin or other antibiotics - either one drug or a combination of two or more drugs is used. Their effectiveness is observed in the treatment of most patients with acute lung abscess.
In addition, conservative therapy includes:
high-calorie balanced diet high in protein and vitamins;
blood transfusions to boost immune defenses;
drug immunotherapy;
anabolic steroid drugs;
parenteral administration of protein preparations - Albumin, Protein;
pyrimidine derivatives - potassium orotate, methyluracil;
Calcium chloride intravenously.

If the abscess is communicated with the bronchus, the purulent contents are removed from the necrotic cavity by the method of postural drainage or, after which antimicrobials are injected into it.
In most cases (about 70%), conservative therapy brings a positive result, but in a fifth of patients acute form becomes chronic.

Death in the treatment of lung abscess occurs in 5% of cases, and the same percentage of patients require surgical intervention.
The operation is carried out under strong pulmonary hemorrhage, as well as with the intensive development of suppuration against the background of drug therapy.

Lung abscess is a necrotic focus in the lung tissue with purulent contents, delimited from the healthy part of the organ by a pyogenic membrane. Currently in developed countries this pathology is quite rare. In most cases, it occurs in immunocompromised individuals, alcoholics, or heavy smokers.

Causes of the disease

A lung abscess can occur in a heavy smoker.

The changes that occur in the lung tissue during an abscess are in many ways similar to those in pneumonia. The formation of a cavity with purulent contents instead of a focus of inflammation depends on the ability of the pathogen to cause necrosis and on the general reactivity of the organism itself. A certain role in this is played by smoking, which contributes to the development and reduction of local immunity.

Often, suppuration in the lungs develops against the background of:

diabetes;
long-term use of corticosteroids;
leukemia;
radiation sickness;
other heavy pathological conditions, reducing protective function organism.

They also weaken the immune system (flu, parainfluenza), which contribute to the development of bacterial inflammation in the lungs.

The most common causative agents of pulmonary suppuration are the following microorganisms:

golden staphylococcus aureus;
klebsiella;
Pseudomonas aeruginosa;
fusobacteria;
group A streptococci;
anaerobic cocci;
bacteroids, etc.

A prerequisite for the formation of a focus of destruction is the penetration of pyogenic microflora into the lung tissue. This is done in 4 main ways:

bronchogenic (aspiration of the contents of the oropharynx, nasopharynx or stomach, as well as inhalation of pathogenic bacteria);
hematogenous (infection with blood flow from the focus of inflammation in osteomyelitis, thrombophlebitis, bacterial endocarditis);
traumatic (eg. gunshot wounds chest);
lymphatic (spread of pathogens with lymph flow).

In rare cases, a lung abscess is formed as a result of direct contact with a purulent focus during a breakthrough of subdiaphragmatic abscesses or abscesses of the liver.

It should be noted that more often than others, suppuration is caused by the aspiration of infected lumps of mucus or food masses. Contributes to this:

state of deep intoxication;
epileptic seizures;
traumatic brain injury;
acute disorders of cerebral circulation.

Main symptoms

In the clinic of an acute destructive process in the lungs, two periods are distinguished:

the formation of a focus of purulent fusion of tissues until the breakthrough of its contents into the bronchial tree;
after the breakthrough.

The first period has an acute onset:

The patient's body temperature rises sharply to febrile numbers, chills appear.
Acute pain in the chest on the side of the lesion, aggravated by deep inspiration, tilt or palpation of the intercostal spaces in the area of the abscess.
From the very beginning of the disease, there is a dry paroxysmal and (as a result of limited chest excursion and development).
At the same time, signs of intoxication appear with severe weakness, sweating, and headache.

The condition of such patients approaches severe. Skin become pale with cyanosis of the lips. The affected side of the chest lags behind in the act of breathing. At the site of the lesion, dullness of percussion sound and weakened vesicular breathing are determined.

As the pathological process progresses, purulent fusion of the bronchus wall begins, which passes through the abscess cavity or close to the pyogenic membrane. Thus begins the second period of the disease.

The patient begins to secrete purulent sputum with an unpleasant odor. Moreover, after the start of emptying the cavity of the abscess, sputum is separated by a “full mouth”. Its quantity can reach 1000 ml.
In this case, the body temperature decreases, and the general condition begins to improve.
Objectively, bronchial breathing with moist rales is heard over the cavity of the draining abscess. In the case of its complete emptying, breathing over the hearth can become amphoric.

At adequate treatment the cavity of the abscess is cleared of pus, deformed and gradually reduced. It may take several weeks or months for it to disappear completely.

In case of insufficient drainage of the cavity, a decrease in overall reactivity or improper treatment the pathological process can continue and become chronic.

Such patients lose their appetite, lose weight.
Their body temperature rises daily with chills and profuse sweats.
A large amount of sputum with a putrid odor is separated.

Complications

If a lung abscess breaks into the pleural cavity, a pyopneumothorax is formed.

The unfavorable course of suppuration of the lungs contributes to the development of complications, often requiring surgical intervention. These include:

Pyopneumothorax.
Pleural empyema.
Subcutaneous.
Pulmonary bleeding.
Sepsis.
Metastatic brain abscesses.
Respiratory distress syndrome.

Diagnostic principles

The diagnosis of "lung abscess" the doctor may suspect in the aggregate clinical signs taking into account the patient's complaints, the history of his disease and an objective examination. Additional laboratory and instrumental studies help him confirm the diagnosis.

A clinical blood test (confirms the presence of bacterial inflammation by the presence of leukocytosis, a shift in the white blood formula to the left, an increase in ESR).
Sputum analysis (when settling, sputum is divided into three layers: the upper one is foamy, consists of mucus mixed with pus, the middle one is a mixture of saliva with a serous component, and the lower one has a heterogeneous structure, it includes pus, fragments of lung tissue, etc. ; at microscopic examination it reveals a variety of microorganisms and a large number of neutrophils).
(at the beginning of the disease, it reveals an area of blackout with fuzzy contours, after opening the abscess - a cavity with thick walls and a horizontal level of fluid).
Computed tomography (is more exact method and is used when conventional radiography data are not enough to make a diagnosis).
(appointed in doubtful cases in order to clarify the localization of the abscess and the patency of the draining bronchus).

The key to success in making an accurate diagnosis is to differential diagnosis With:

tuberculous cavity;
festering cyst;

Treatment

Due to the severity of the current and high risk development of complications, treatment of infectious destructions of the lungs is carried out in a hospital.

Conservative treatment is aimed at suppressing the infectious process, adequate drainage of purulent cavities and their sanitation.

All patients with lung abscess are given antibiotic therapy. At the first stage, drugs from the group of aminoglycosides, cephalosporins, macrolides, carbapenems in high doses are used. After bacteriological examination of sputum and determination of the sensitivity of pathogenic microorganisms to antibiotics, therapy can be adjusted. In this case, the course of treatment averages 6 weeks.
In order to improve bronchial patency and drainage, bronchodilators, expectorants and mucolytic drugs are prescribed. If these measures are not effective, such patients are shown repeated endoscopic sanitation with intrabronchial administration of antiseptics, antibiotics and proteolytic enzymes.
In parallel with this, detoxification therapy is carried out with by intravenous infusion plasma-substituting solutions, hemosorption. If indicated, oxygen therapy is used.
To improve the impaired immunological reactivity, various immunocorrectors are used (thymus preparations, etc.).

With inefficiency conservative therapy or the development of complications in such patients, surgical treatment is indicated.

Conclusion

The prognosis for a lung abscess is determined by the severity of its course, the presence of complications, the general reactivity of the body and the adequacy of the therapeutic tactics for managing the patient. Mortality among patients with suppuration of the lungs reaches 10-15%.

It should be noted that in most cases, with timely and proper treatment in patients with an acute destructive process in the lung tissue, clinical recovery occurs. Some of them with complete obliteration of the pathological focus, and some with preservation of the cavity and pneumofibrosis around it. At the same time, good drainage and epithelialization of the inner surface of the abscess cavity contribute to the cessation of the purulent process. This state may last for many years, but adverse conditions that weaken the immune system, a repeated outbreak of infection with the development of the disease is possible. In 15-20% of these patients, a chronic lung abscess develops.

A specialist at the Moscow Doctor clinic talks about a lung abscess: