Localized lesion in the lung is called suppurative lung abscess. Tuberculous and ' cystic cavities, is taken into account even though secondary infection by pyogenic organisms, usually not under this term.
Reasons
1. Aspiration pneumonia: Aspiration of stomach contents or materials from the upper respiratory tract occurs in a coma, anaesthesia or deep sleep.
2. other types of Pneumonias
3. systemic pyemia
4. secondary infection of pulmonary Infarcts
5. Necrosis and infection of bronchogenic Carcinoma
6. spread of amoebic liver abscess and primary pulmonary amoebiasis
7. Bronchial obstruction leads to abscess formation distally.
Impairment of cough due to painful conditions in the chest or in the post-operative period and conditions that impair Ciliære function (heavy smoking or bronchitis) predispose abscess formation. Right lower lobe is the most common Web site to the aspiration and suppuration. In a coma patient suffering this supinely axillary segment right upper lobe apical segment and in the right lower lobe is the most dependent parts more often. Next in frequency is the corresponding segments to the left.
Pathology
Suppuration and necrosis of lung tissue forms the basic pathological process. Abscess is lined by granulation dryer tissues, limiting the spread of infection. Common organisms is derived from the upper respiratory tract and foot. These include ærob and anærob streptococci, staphylococci, pneumococci and spirochaetes. E. coli, Clostridia and b. Proteus may less commonly be present. When the abscess ruptures in a Bronchus, expectorated inflammation. The cavity contains pus and air. The wall is thick and rough compared with tuberculous cavities or potato cyst nematodes. Chronic abscesses may be multiloculated. When the content is complete, the cure by fibrosis.
Clinical features
Early symptoms are pneumonia with fever, cough, malaise, rigor, and pleuritic chest pain. Originally cough may be unproductive. Hemoptysis is not uncommon. When the abscess breaking in Bronchus cough becomes postural. Sputum is a large quantity (300-500 ml/day), purulent, blood-stained and disgusting smelling systemic symptoms depends on virulence organisms and patient's general condition. The patient is in a moderately severe cases, febrile, toxic and dyspneic. Painful clubbing in the fingers and toes developer in a few weeks.
Physical examination may reveal the presence of consolidation due to the surrounding pneumonic process. Pleura-rub can be heard. When the abscess opened in a Bronchus, heard the auscultatory signs of cavernous and grove post-tussive crepitations.
Results of laboratory tests
Neutrophil leukocytosis can be found in most cases, to leave it in a conical glass, settles in sputum for typically three layers (foam above, serous part in middle and thick medicine response particles below). The organisms can be identified by gram staining and culture.
X-Ray chest reveals consolidation with clearance in its centre. A partial drain abscess is seen as a cavity containing fluid and is necessary to find abscess. Tomography provides additional information about abscess wall and its contents.
Diagnosis
It is found by clinical examination and chest x-ray. Etiology may be determined by microbiological examination of sputum. Help with bronchoscopy to visualize the main bronchi that exclude obstruction and new growths and also aspirate sputum for further studies. It can also help in cleanup obstruction and allow drainage.
Complications
Pulmonary
Serious Hemoptysis
Extension to other parts of the lung and on the other side
Empyema, pyopneumothorax and Pleurisy; and
Local lung fibrosis and bronchiectasic changes
Extrapulmonary complications
Brain abscess can develop due to Metastases of septic embolism from in the lungs, as when cerebral circulation through the vertebral system of veins (Batson's system). Other complications include pulmonary Osteoarthropathy, emaciation and cachexia is due to the loss of large amounts of proteins (in the form of purulent sputum) and infection. If left untreated, proves fatal lung abscess.
Differential Diagnosis
Lung abscess is distinguished from bronchiectasis, bronchogenic Carcinoma, lung tuberculosis, fungal infections, pulmonary cysts and secondary neoplasms. Bronchiectasis is more chronic and usually bilaterally. A cavitating bronchogenic carcinoma may resemble a abscess clinical and radiologically. Carcinoma is more common in smokers. Sputum is rarely heavy, or purulent. It is more frequently blood stained with necrotic tissue become expectorated at times. The presence of hilar Lymphadenopathy is in carcinoma. In cavitary pulmonary tuberculosis is often not mucoid sputum and foul smelling. Digital clubbing is less common. Tuberculosis affects the upper lobes often, abscess usually occupies the lower lobes. X-Ray reveals thin-walled cavities without free liquid level.
In endemic areas, Lung abscesses should be examined for fungal pathogens of sputum samples and immunological investigations. ' Cystic disease of the lungs is often bilateral and present from early life. Radiologically, cysts appear thin walled. Cysts can rarely be lonely. Digital clubbing is less marked in the ' cystic disease in the lungs.
Treatment
Principles of therapy include anti-microbial drugs, drainage of the abscess cavity and surgery in difficult cases.
Antibiotics
Correctly collected sputum uncontaminated by pharyngeal microbes should be sent to the culture and sensitivity studies and antibacterial drugs should be given in the appropriate dosage till radiological clearance is completed. In most cases, the recovery fully in 4-6 weeks. Anærob infection has dealt with the supplier, where intravenous 500 mg every 8 hours. Drainage of the abscess is achieved by postural drainage and gentle tapotement over the chest. Respiratory physiotherapy to help stimulate cough and expectoration initiated early. If the security clearance of the abscess is unsatisfactory, bronchoscopic aspiration can help. With proper medical treatment, the majority of lung abscesses healed.
Surgery
It is listed under certain circumstances such as lack of medical treatment, remaining fibrosis with changes bronchiectatic, suspicion of bronchogenic Carcinoma, serious hemoptysis and pleura-suppuration. If the condition does not show improvement after a reasonable course of medical treatment, surgery should not be delayed indefinitely. Necessary surgery should be performed before the general condition of the produce.
Prevention of lung abscesses
Lung abscess is largely a preventable disease, which can be the same by preventing aspiration pneumonia. Other measures include the quick removal of bronchial obstruction, complete treatment of pneumonia and early diagnosis of pulmonary suppuration.
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