An abscess is formed in the lungs due to purulent fusion of lung tissue, provoked by purulent or aspiration pneumonia, pulmonary infarction, breakdown of a cancer tumor, septicopyemia and a number of other factors. A lung abscess on a radiograph looks different depending on the stage and state of neglect of the process.
The form of inflammation of the lung tissue on x-rays depends on the following factors:
- Process stage:
- in acute – the correct shape with indistinct contours;
- in chronic – irregular shape with multiple “pockets”.
- The size of the purulent-destructive process:
- small – at least 2 cm in diameter;
- large – more than 10 cm in diameter.
- Abscess structure:
- homogeneous – until a breakthrough in the bronchus;
- sharply inhomogeneous – after a breakthrough with visualization of enlightenment and a horizontal level due to the appearance of gas and liquid in the cavity.
In the early stages, an X-ray image does not give a clear picture of the disease and may look like focal pneumonia, for example. A characteristic feature of the chest X-ray at this stage is the presence of darkening with uneven contours in the pulmonary region.
X-ray signs in the stage of decay (breakthrough of an abscess into the bronchi) are distinguished by a more pronounced picture, which makes it possible to determine the cavity with the liquid level, to see the gas located above the liquid in the form of a clarified semicircle.
To identify the size and location of the cavities, it is recommended to take pictures at several stages of filling the pleural cavity with fluid, for example, before and after expectoration and in several projections. The abscess cavity on X-ray images most often has an oval shape.
Lung tissue abscess is an acute pathological process, which is a nonspecific inflammation of the lung tissue, accompanied by the formation of a limited cavity in the lung tissue as a result of its death and purulent fusion. The location of the abscess is varied, but most often the lesion occurs in the upper lobe of the right lung. According to statistics, this disease is more common in men of average age 25-50 years, compared with women in a ratio of 10: 1.
For the accuracy of such a diagnosis, use:
- collection of anamnesis of the patient (recent complaints);
- auscultation (listening);
- percussion (tapping);
- palpation (probing) of the upper and lower chest;
- laboratory research of biological materials;
- instrumental studies (X-ray diagnostics, chest tomogram for a more accurate picture – at the discretion of the doctor).
The main signs
This disease can be both acute and chronic. Due to reduced immunity or unqualified and untimely assistance in the treatment of the acute form, the following symptoms are observed:
- drowsiness;
- weight loss (up to exhaustion);
- barking (barking) cough, manifested in the form of seizures;
- copious discharge of offensive phlegm;
- hyperhidrosis (increased sweating).
The clinical symptoms of a lung abscess are different throughout the course of the disease, its severity and severity directly depend on the stage of the disease, of which there are only two:
- Formation of the fusion cavity. It is accompanied by the following symptoms: a long-term sustained increase in body temperature, general malaise (dizziness, chills), disorders of the respiratory system (changes in the frequency of respiratory contractions, severe shortness of breath), pain in the sternum, the appearance of an unproductive dry cough, which eventually turns into a productive one, separating purulent sputum.
- Opening and discharge of exudate (purulent masses contained in the lung cavity). During the second stage, the actual breakthrough of the abscess and drainage of the pleural cavity, there is an increase in the above symptoms of the first stage, to which the release of a large amount (100-1500 ml per day) of purulent sputum with a putrid odor is added. At the same time, after the abscess breaks through, the patient feels a decrease in intoxication, an improvement in the general condition. An X-ray image in the lung shows a clearly marked decay cavity with an air-liquid level occupying 1/3 of its volume.
Predisposing factors
There are many reasons for the development of a pulmonary abscess; it is classified as a nonspecific polyetiological disease. The risk group includes:
- people with diabetes mellitus;
- patients with bronchiectasis or any bronchial infections, most often pneumonia;
- people suffering from alcoholism, it is often fraught with vomiting into the lungs, this is also one of the risk factors for an abscess.
Lung infarction caused by blockage of any of the branches of the pulmonary trunk, as well as direct damage to the human chest, can lead to an abscess.
Treatment methods
Treatment consists in active complex conservative therapy and even in surgical intervention – with ineffectiveness of drug treatment, chronic course of the disease or the development of various complications.
Treatment algorithm for abscess:
- sanitation of the oral cavity and respiratory tract:
- removal of purulent contents;
- postural drainage (a certain position of the body, often lying on a healthy side, used to improve the quality of sputum discharge);
- vibration massage procedures;
- special breathing exercises;
- carrying out a bronchoscopy in order to sanitize the exudate throughout the entire bronchial tree (using a similar procedure, the necessary drugs can also be administered).
With an abscess, the following groups of medicines are most often prescribed:
- mucolytic drugs (to improve sputum dilution);
- antiseptic agents (for washing the affected cavity);
- antibiotic therapy (with previous detection of flora sensitivity to them);
- bronchodilators (prescribed to improve the discharge of exudate);
- immunomodulators.
Intensive therapy consists of the following activities:
- intensive infusion (elimination of hypovolemia, restoration of electrolyte balance, correction of the level of protein in the blood);
- detoxification (use of forced diuresis, plasmapheresis);
- oxygen therapy with sodium hypochlorite for blood oxidation;
- hemofiltration;
- dietary food with increased calorie content (if necessary, it is carried out parenterally).
With the ineffectiveness of conservative treatment, surgical intervention is used:
- Puncture of the pleural area (puncture of an abscess) using a special elongated needle in order to remove purulent contents, rinsing the cavity with antiseptic agents for further administration of antibiotics. It is performed when the size of an abscess does not exceed 5 cm in diameter.
- The abscess must be drained with thoracocentesis. It is carried out to evacuate the contents (purulent sputum and air). A special perforated drainage tube is introduced into the pleural cavity, which is connected to an aspirator or siphon according to the Bulau method, it provides a passive outflow of exudate.
- Resection (removal) of the required volume and part of the lungs. This type of surgical intervention is typical for chronic abscesses, when conservative treatment is ineffective.
Puncture of the pleural region
This procedure has a number of contraindications, especially on the part of the cardiovascular system and in severe respiratory failure. The sad statistics of mortality after the intervention are also present and amount to 3-10% of all cases.
With multiple lung abscesses, a wide pneumotomy is used, that is, a total opening of all possible abscesses on the affected area of the lung, which is not always possible. With a successful surgical intervention, there is a positive dynamics of the patient’s condition, a way out of the state of severe intoxication. In the opposite case, a serious consequence is possible – bronchial fistulas, requiring again to resort to surgery.