The body lung disease pus is not harmful to life. Lung abscess: symptoms, treatment, complications and pathogenesis. Causes and mechanism of development

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

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 severe pathological conditions that reduce the protective function of the body.

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 (for example, with gunshot wounds of the 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. The skin becomes 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.

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

In the case of insufficient drainage of the cavity, a decrease in general 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

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

1. Pyopneumothorax.
2. Pleural empyema.
3. Subcutaneous.
4. Pulmonary bleeding.
5. Sepsis.
6. Metastatic brain abscesses.
7. Respiratory distress syndrome.

Diagnostic principles

The doctor may suspect the diagnosis of "lung abscess" based on the totality of 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.

1. 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).
2. 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. microscopic examination reveals a variety of microorganisms and a large number of neutrophils).
3. (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).
4. Computed tomography (is a more accurate method and is used when conventional radiography data is not enough to make a diagnosis).
5. (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 differential diagnosis with:

• tuberculous cavity;
• festering cyst;

Treatment

Due to the severity of the course and the high risk of complications, the 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.

1. All patients with lung abscess are treated with antibiotics. 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.
2. 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.
3. In parallel with this, detoxification therapy is carried out with intravenous infusion of plasma-substituting solutions, hemosorption. If indicated, oxygen therapy is used.
4. To improve the impaired immunological reactivity, various immunocorrectors are used (thymus preparations, etc.).

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

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 condition can last for many years, but under 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:

Lung abscess most often develops against the background of infectious inflammatory diseases, acting as their complication. Without proper 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.

The most common causes of abscess are Staphylococcus aureus, aerobic gram-negative bacteria, and anaerobic non-spore-forming organisms.

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 various factors. In most cases, there is a combination of lung abscess and pneumonia. Also, purulent-necrotic cavities appear due to the ingress of a foreign body with an infection into the lung - 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;
• the cavity is lined with 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 the cavity walls are formed by fibrous tissue, then suppuration can exist for a long time, and the lung abscess takes on a chronic character.

The risk group includes not only people with inflammatory diseases of the oral cavity, 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 of the right or left lung) or bilateral, central and peripheral.

Signs and symptoms of a lung abscess

Signs of an acute lung abscess are manifested by a 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 an x-ray of the lungs, a rounded shadow is visible;
• a blood test shows an increase in ESR and leukocytes.

Symptoms of a lung abscess after an abscess rupture:

• profuse sputum production - up to a liter per day;
• improvement of 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.

It is more difficult to diagnose the disease in the early stages before the breakthrough of the abscess, 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:

1. blood test;
2. Radiography;
3. Listening to the lungs with a stethoscope and phonendoscope (auscultation);
4. 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. In the 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, broad-spectrum antimicrobials are prescribed.

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 with a high content of proteins 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, the 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 performed with severe pulmonary bleeding, as well as with the intensive development of suppuration against the background of drug therapy.

Pleurisy (pus in the lungs) is the most dangerous and common disease. In 15% of cases, after this disease, complications appear. In practice, pathology as an independent and separate disease can be encountered quite rarely. Most often, it occurs as a result of the transfer of severe complications. At the first suspicion of the appearance of this symptom, you should immediately seek qualified medical help at the clinic.

Etiology of the disease

It is necessary to understand what this disease is and as a result of which it appears. Pleurisy is an inflammatory process that forms on the membranes surrounding the lung. The disease itself develops very individually. Infectious processes, accompanied by the formation of pus in the lungs, are diverse in their etiology.

If the inflammation is exudative in nature, then a certain amount of fluid accumulates between the pleural lobes. In medicine, this disease is called pleural empyema. If there is no liquid, then fibrin (protein) begins to deposit on the surface. In some cases, the accumulation of pus is observed between the petal cavities of the organ. There are other pathologies that are characterized by the presence of infectious formations. First of all, it is gangrene or lung abscess, which have one common name - acute pulmonary suppuration. They are quite severe and can lead to dangerous consequences, for example, the collapse of lung tissue, and this is already dangerous for human life. Most often, such a disease is awakened due to Staphylococcus aureus, but other microorganisms and enterobacteria can also act as a pathogen.

Causes of pus

The causes of pus in the lungs, as well as the consequences, are different:

• if pathogenic foreign bodies have entered the human body;
• inflammation of the lungs, which were obtained as a result of the formation of anaerobes or staphylococcus aureus;
• tiny organisms that came to a person by hematogenous route or as a result of prostatitis, as well as the presence of a boil on the upper lip.

Causes of gangrene in the lungs

The causative agent of gangrene is a putrefactive infection that enters the body through the bronchogenic route. What causes gangrene to develop?

• in case of acute pneumonia;
• with bronchiectasis;
• if there is a tumor;
• the presence of foreign bodies in the bronchi;
• lung wounds.

Initially, the disease appears in the lung parenchyma. In the future, it depends on what type of microbial flora was introduced whether the detachment of the necrotic part occurs, or whether pus melts and severe suppuration of the lung develops.

How to determine if there are purulent formations on the lung?

The main signs of such a disease are: severe pain, a feeling of heaviness, ailments in the side, heavy breathing. The patient develops a cough and shortness of breath, the body temperature is above normal, the patient does not leave the feeling of weakness. When the pus becomes more and more, the pain slowly subsides. If there is a cough, it is usually dry. With a relapse of this disease, which has developed as a result of a complication of inflammation, abundant dirty sputum appears along with pus. It happens that the cough becomes simply unbearable, and even comes to attacks, especially at night. Body temperature can rise above 39 degrees, which is very life-threatening. It can hold without falling, or rise after a while. In addition, the human heart rate also increases. This happens due to the fact that the pus is intoxicated and at the same time the heart moves to the side.

If a person is not provided with qualified assistance in time, pus can also pass to the pleural cavity. Along with this, air also accumulates in it. As a result, the patient begins shortness of breath and acute pain. When the disease passes from an advanced stage, scars begin to form on the lung and bronchiectasis develops. Inflammations begin to recur regularly and periodically become seriously aggravated.

Diagnostics

Diagnosis begins with a visual examination, the chest is auscultated and tapped, anamnesis is collected, however, it will not work to make a true diagnosis only on the basis of the patient's claims. For clarification, laboratory and instrumental studies are needed. As a rule, computed tomography, x-rays and ultrasound examination of the chest organs are prescribed to diagnose the disease. It is often required to take the fluid of the pleural area for a test in order to qualify its nature. For all this, a puncture is performed under general anesthesia. If there is an assumption that the disease has arisen due to a tumor of the pleura, a biopsy is performed - a small part is separated from it with a special probe, which is then sent for a test. The biopsy is also performed under local anesthesia. The main difficulties in identifying such a disease are that its symptoms are quite skillfully disguised as another disease. The situation is aggravated even if the patient is not able to establish regular monitoring. Another disadvantage is that the disease is almost impossible to detect in the initial stages.

To diagnose the disease, the doctor needs to do a considerable number of activities, subsequently combining all the results.

Required Methods

The mandatory methods of examination of the patient include:

• attentive conversation on the topic of complaints, listening to the patient about any illness and clarifying the necessary questions;
• visual inspection;
• conducting laboratory research;
• it is necessary to appoint the necessary additional examinations;
• use bacteriological methods obtained during puncture for studying sputum and fluid;
• take a chest x-ray;
• do an ultrasound;
• perform computed tomography;
• if necessary, do also thoracoscopy of the lungs.

Changes in the patient's appearance

Be sure to pay attention to the color of the patient's skin, the degree of pallor and the condition of the lips. On examination, the doctor determines whether the patient has breathing restrictions in that part of the chest that is affected by the disease. Be sure to do tapping on the easy. All these methods will help the doctor to understand with almost accuracy how much the disease has affected the patient, and what the nature of the pathology is. If percussion is performed, then in those places where there are purulent accumulations, the sound will be most muffled. In cases where auscultation is performed with a large volume of plavrite, breathing in the lower part of the patient's lungs may be completely absent.

Treatment

The disease can be cured through surgery. It is required only in severe cases. The base of drug treatment of pus in the lungs in a child is based on bactericidal agents. At the beginning, drugs of a wide range of effectiveness are prescribed, and subsequently, according to the results of the analyzes, substances of "point action" are chosen. In parallel with antibiotics, anti-inflammatory and anesthetic substances should be prescribed.

If pleurisy is considered a consequence of the tumor process, glucocorticoid hormones and substances that slow down the growth of the neoplasm are injected inside. At times, diuretics, cough medicines, and pharmaceuticals are also prescribed to help normal vascular function. Drug therapy is diluted with physiotherapy, in particular, these are all kinds of warming up. However, limited treatment does not always bring positive results.

When water accumulates in large quantities, it has a negative effect on other organs. Sometimes the operation has to be carried out more than once, because during its implementation it is possible to pump out no more than one liter of water. Otherwise, there is a risk of damage to internal organs.

How to remove pus from the lungs by other methods? Often, the patient needs to periodically drain, and the frequent repetition of such an operation is dangerous. In this case, it is advisable to take the device of the pleural port system, which eliminates the need for repeated operations. A special port is built into the patient under the skin, combined with a drainage tube, which is inserted into the pleural cavity. If a pleural effusion occurs, you can only pierce the port membrane and remove the fluid.

Another advantage of the pleural port is the ability to carry out chemotherapy by injecting substances into the affected area directly through this device. This setting allows you to administer drugs for a long period of time. Now the intrapleural port system is one of the popular non-hazardous ways to get rid of pleural fluid stagnation.

Diseases of the lungs, in which the presence of pus in them is characteristic, is an abscess and gangrene of the lungs, united in medicine by the term “acute pulmonary suppurations”. These are severe pulmonary diseases, leading to serious consequences - purulent or putrefactive decay of the lung tissue, often threatening the life of the patient.

The causative agent of a lung abscess is most often Staphylococcus aureus, but it can be almost any microorganisms - streptococci, hemolytic staphylococcus, Klebsiella pneumoniae, Pseudomonas aeruginosa, Proteus and other types of enterobacteria.

Causes of a lung abscess:

• caused by anaerobes, Klebsiella or Staphylococcus aureus;
• entry of infected foreign bodies;
• microorganisms that penetrate hematogenously in osteomyelitis, prostatitis, drive or lymphogenous in phlegmon of the bottom of the mouth and upper lip.

Gangrene of the lung is caused by an anaerobic (putrefactive) infection, which is characterized by a bronchogenic route of penetration.

Reasons for the development of gangrene:

• acute pneumonia;
• bronchiectasis;
• tumor formations;
• entry into the bronchi of a foreign body;
• mechanical damage to the lung (wounds).

Both acute abscess and gangrene of the lung are initially manifested by necrosis of the lung parenchyma. Subsequently, depending on the type of microbial flora and the resistance of the organism, either separation of necrotic areas occurs, or purulent-putrefactive fusion of the surrounding tissues and acute suppuration of the lungs.

Lung abscess is a nonspecific disease and is accompanied by purulent or putrefactive fusion of necrotic areas of lung tissue, usually within one segment, and the formation of one or more purulent cavities. At the same time, the purulent cavity in the lung is delimited from the unaffected areas by a kind of capsule.
Pulmonary gangrene is characterized by purulent-putrefactive decay of the affected lung tissue, which is not separated by a capsule from the adjacent tissue, and is prone to progression, which leads to a very difficult general condition of the patient and an unfavorable outcome.

Gangrenous abscess - more favorable compared to the course of the disease. This is a purulent-putrefactive decay of areas of necrotic lung tissue with a tendency to delimit from unaffected areas.

Acute pulmonary suppurations develop more often in men of mature age, who are ill 3-4 times more often than women. This is due to smoking, alcohol abuse, occupational hazards, and a tendency to hypothermia.

Purulent diseases of the lungs are characterized by high fever, weakened breathing, chest pains that increase with coughing. If the abscess breaks through, pus with an unpleasant odor comes out with a cough, sometimes with an admixture of blood. Gangrene is characterized by dirty gray copious sputum, it is often complicated by coughing up blood, bleeding.

You are an active person who cares and thinks about your respiratory system and health in general, continue to play sports, lead a healthy lifestyle, and your body will delight you throughout your life, and no bronchitis will bother you. But do not forget to undergo examinations on time, maintain your immunity, this is very important, do not overcool, avoid severe physical and severe emotional overload.