Lung abscess

Lung abscess

Lung abscess (lung abscess) is due to a variety of pathogens from the lungs purulent infection, for early lung infection and inflammation, then necrosis, liquefaction, a week, surrounded by a granulation tissue abscess. Characterized by high fever, coughing, bronchial abscess after Kechu Pokui into the septic smell a lot of sputum. X-ray showed that with the gas-liquid-cavity. Many occurred in their prime, men more than women. Since the wider use of antibiotics, the incidence rate has decreased significantly.

Acute bacterial infection of lung abscess in general and oral, upper respiratory tract of the bacteria often in line, including aerobic, anaerobic and sexual and anaerobic bacteria. The past 10 years, due to anaerobic training and technological progress, aspiration pneumonia and acute lung abscess of anaerobic bacteria infection of 85% -94%. Anaerobic bacteria infection was reported in 58 per cent of lung abscess; aerobic and anaerobic bacteria infection 42 per cent. The more important anaerobic bacteria Streptococcus suis have peptone, peptone cocci, nuclear tablets spindle bacteria, producing melanin bacteria, Bacillus stomatitis and Weirong MI; common of aerobic and anaerobic bacteria and for pneumococcal, golden yellow Staphylococcus aureus, hemolytic streptococcus, Klebsiella, E. coli, Pseudomonas aeruginosa, Proteus, and so on.

According to infection channels can be divided into the following types of lung abscess.

1. Inhalation lung abscess

Pathogens by mouth, nasopharyngeal aspiration for lung abscess cavity incidence of the main reasons. Under normal circumstances, have sensitive respiratory cough reflex, to prevent aspiration. However, there are tonsillitis, sinusitis, the cutting of septic tank overflow or Nongxing secretions such as dental caries; mouth, nose and throat surgery after the clot, or vomit tooth scale, in a coma consciousness, anesthesia and other circumstances, or As Shouhan, extreme fatigue, and other incentives for the effects of systemic immune function and lower respiratory tract defense, in deep sleep when various pollutants can be inhaled through the lungs trachea, bronchial obstruction caused by small, breeding and disease pathogens. Inhalation lung abscess often single, and its incidence and anatomical structure and location of the site. The right of the bronchial more steep and coarse diameter, easy to inhalation of respirable right lung. In the supine position, well after the last of the paragraph or under Yebei; seat at the aspiration, occurred in the basement of the following paragraph; right place, then good on the upper right of the preceding paragraph after paragraph, or the formation of axillary Sub-paragraph.

Second, secondary pulmonary abscess

In some bacterial pneumonia, bronchiectasis, bronchial cyst, bronchial lung cancer, tuberculosis, and other empty secondary infection caused by the secondary pulmonary abscess; adjacent organs suppurative lung disease, such as subphrenic abscess, kidney abscess around, spinal abscess , Or esophageal perforation of the lung perforation to the formation of lung abscess; should note that amoebic liver abscess in the right suprahepatic good at the top, easy to perforation of the right lung and diaphragm, a lung abscess amoeba.

Third, blood-borne lung abscess

Skin infections due to injury, carbuncle Boils, the bone marrow caused by sepsis, septic germ bolt spread to the lung blood lines, caused small blood clots, inflammation, necrosis and a lung abscess. Zhou Liang Fei, often for the Ministry of multiple lesions. Staphylococcus aureus bacteria to the common.

[Pathology]

Fine obstruction of bronchial infection, inflammation of small blood vessels embolization, suppurative lung inflammation, necrosis, a lung abscess, and then necrotic tissue liquefied Pokui to bronchial, Nongye from some form of a liquid-Vomica, hollow wall surface Common residues necrotic tissue. Examination showed a large number of acute pulmonary abscess neutrophil infiltration, with the largest amount ranging from mononucleosis, has a tendency to expand around, or even exceeded between fissure leaves, and adjacent to the extension of the lung. If the abscess near the pleura, a limitation of fibrin pleurisy, a pleural adhesions; tension such as abscesses, Pokui to the pleural cavity, can form pus pneumothorax. The positive acute lung abscess antibiotic treatment, if the airway open, Nongye from the airway, and Vomica gradually disappear.

Chronic lung abscess due to the acute phase is not complete treatment, bronchial or poor drainage, in patients with acute lung abscess, 70% -90% of cases of acute onset, and most have teeth, the Gan Ranzao oropharynx, or surgery , Tiredness, Shouliang, such as history. Patients with flu chills, fever, body temperature of 39-40 ℃, with coughing, phlegm or mucus cough mucus Nongxing sputum. Pleural inflammation can cause chest pain involved, and is breathing on. The scope of the disease, there will be short breath. At the same time, Jingshenbuzhen, malaise, anorexia, and other symptoms of systemic toxicity. If unable to control infection in the pathogenesis of 10-14 days, suddenly Kechu large number of septic smell sputum and necrosis, a day up to 300 - 500ml. Tanduo smell of infection caused by anaerobic bacteria. About 1 / 3 patients have different degrees of hemoptysis, occasionally, a sudden massive hemoptysis and died of suffocation. Kechu large Nongtan in general, decreased body temperature, then reduce the symptoms of systemic toxicity, a few weeks of the general situation gradually returned to normal. Some patients slow onset, the general symptoms of respiratory tract infection, such as cough, cough and hemoptysis Nongtan, with high fever, chest pain, and so on.

Lung abscess Pokui to pleural cavity, the chest pain of sudden, short breath, a septic pneumothorax.

Empyema often in patients with chronic cough, cough Nongtan and repeated and repeated hemoptysis fever, anemia, weight loss and other performance.

Blood-borne lung abscess more first primary lesions caused by chills, fever and other systemic sepsis performance. After a few days or weeks after a cough, sputum, sputum is light, very few of hemoptysis.

Signs and lung abscess the size of the site. Smaller lesions in the lungs or the deep, have no abnormal signs; larger lesions, a large number of inflammation around the abscess, or Kouzhen Zhuoyin it was the sound, because of the poor respiratory airway to reduce the sound, and sometimes can be heard and wet-La; complicated by pleurisy , And pleural friction can hear the sound or the signs of pleural effusion. Chronic lung abscess often clubbed fingers (toe). Blood-borne lung abscess signs are negative.
Large number of necrotic tissue residue Vomica, Vomica wall fibroblast proliferation, granulation tissue to Vomica wall thickening. In the course of a lung abscess, necrosis in the remnants of the blood vessels lose the support of lung tissue, the wall of blood vessel damage can form part of, this is repeated, massive hemoptysis the pathological basis. Granulation tissue vascular wall surface than the rich, can cause cough or sputum Nongxue a small amount of hemoptysis. Lung abscess of the pathological changes can be involved around the bronchiole, or deformation of its expansion. Clinical on the March-June or so the healing can not be called chronic lung abscess abscess.

[Laboratory]

Acute lung abscess total number of blood leukocytes (20-30) × 109 / L, neutrophil in more than 90 percent, nuclear obviously the left, often toxic particles. Ke Chu was typical of sputum Nongxing, yellow-green, blood folder, kept layered. The blood of patients with chronic interleukin be normal or slightly increased, reducing red blood cells and haemoglobin.

Bacteriological examination of sputum: I Kechu the sputum is very susceptible to bacteria contamination of regular oral; Kechu should be timely for the sputum culture, or pollution of the large number of breeding at room temperature, the bacteria found it difficult, and contact with air after burnout Demise of oxygen, can affect the reliability of bacterial culture. So acute lung abscess Nongtan direct smear the stain that many bacteria, such as α-hemolytic streptococcus, such as Neisseria often of the oral bacteria do not even find pneumococcal, Staphylococcus aureus, the source of intestinal Gram-negative bacteria stain , Pseudomonas aeruginosa, the bacteria are not necessarily lung abscess. Central to puncture a thin membrane catheter more in-depth lessons in sputum, can reduce oral bacteria contamination. Bronchoscopy using the dual-fiber casing Pollution Prevention brush, to focus sputum, for examination and smears were aerobic, anaerobic training, it can clear its pathogens. Sputum examination should seek prior to the introduction of antibiotics. Bacteria drug sensitivity tests to choose effective antibiotics.

With empyema, chest Nongye of aerobic and anaerobic training more reliable than the sputum. Primary acute lung abscess not accompanied bacteremia, the blood culture in the diagnosis of little help, and the blood-borne patients with lung abscess blood culture can be found pathogens.

[X-check]

Inhalation lung abscess for suppurative inflammation early stage, X-ray showed large shadow of dense infiltration fuzzy, unclear edge, or for the corporation patchy dense shadow of a lung or a whole paragraph. Abscess formation, Nongye from the bronchial, Vomica lucent and a round of planes, surrounded by dense infiltration surrounded by inflammation. Absorption recovery, the Nongye drainage and antibiotic treatment, lung abscess inflammation around the first absorption, gradually narrowing to Vomica disappeared, only the last remnants of the fiber cable shadow. Chronic lung abscess Vomica wall thickening, wall irregular, and sometimes a room, surrounded by fibrous tissue proliferation and neighbouring pleural thickening and lung contraction, mediastinal shift to the side.

With empyema, a large chest side dense shadow; if associated with pneumothorax can be seen by plane.

X ray inspection can clear the site of lung abscess the size and scope, contribute to postural drainage and surgical treatment.

Bronchial angiography usually used for suspected chronic lung abscess, with bronchiectasis.

Blood-borne lung abscess, the distribution of lesions in one or two sides were scattered in the limited block inflammation, or the edge of the ball neatly lesions, a small central Vomica and liquid-ping. Absorption inflammation, may also be a focal fibrosis or small balloon shadow of the aftermath.

[Branchofiberoscopy]

Help to identify the causes and timely treatment. See if the foreign body should be removed to facilitate foreign body airway open drainage; suspected tumor obstruction, a biopsy will be diagnosed and should Branchofiberoscope the catheter as close as possible to Vomica, strengthening Nongye attract and lesions injection of antibiotics to improve Efficacy and shorten the course.

To have oral surgery, unconscious after inhaling vomit or foreign body, sudden chills, fever, cough and cough a lot septic smell in patients with a history of sputum, and so on, the total number of leukocytes and blood neutrophils were significantly higher, X-ray showed thick inflammatory In the shadow of a cavity, liquid-ping, made the diagnosis of acute pulmonary abscess is not difficult. A skin wound infection, boil, carbuncle, such as purulent lesions, with fever not to cough, sputum, and other symptoms, X-ray showed multiple small abscess Liang Fei, can be diagnosed with blood-borne lung abscess. Sputum, blood culture, including anaerobic bacteria and drug sensitivity tests to determine the diagnosis and guide the selection of antibacterial drugs have significant value.

Lung abscess should consider the following identification of the disease.

First, bacterial pneumonia

Early lung abscess with symptoms of bacterial pneumonia in chest X-ray film and performance is very similar, but common with many of Streptococcus pneumoniae pneumonia lips herpes, rust sputum, not a large number of septic smell sputum; X-ray showed lung or Paragraph of real change, or a flake weak inflammatory diseases, blurred edges, no cavity formation.

Second, empty secondary infection of tuberculosis

Empty tuberculosis is a chronic, often systemic and respiratory symptoms, without the toxic symptoms of severe acute cough and phlegm large number of septic smell, the sputum may find TB diagnosis. But with suppurative bacterial infection, acute infection can occur more Nongtan symptoms and cough, because of purulent sputum difficult to breed a large number of bacteria Mycobacterium tuberculosis detection. As with the past without the typical history of chronic tuberculosis and clinical performance, easy to empty secondary tuberculosis infection misdiagnosed as lung abscess. So to be careful medical history and asked to identify X-ray whether chronic tuberculosis pathological changes in the diagnosis of tuberculosis empty help. If time can not be identified, can control the treatment of acute pulmonary abscess acute infection, the chest film shows empty and the surrounding fibers of the multi-TB change. Sputum-TB can be transferred.

Third, Lung Cancer

Bronchial obstruction bronchial lung cancer often caused remote suppurative lung infection, but lung abscess formation of the relatively long duration, due to a gradual obstruction of the process, the more toxic symptoms was not obvious, Nongtan amount is less. Obstructive bronchial infection due to poor drainage, antibiotics difficult to control inflammation and fever, in more than a 40-year-old local repeated lung infections, antibiotics and the effect of poor patients, to consider a lung cancer caused by obstruction of bronchial pneumonia may be routine for defibrillators - Examination. A clear diagnosis. Bronchial cancer lesions can occur liquefied necrosis, a hollow, but in general non-toxic or acute symptoms of infection. X-ray showed thick wall empty, empty Duocheng eccentricity, residues of the tumor so that rugged wall, around the empty also less inflammatory infiltration, hilar lymph nodes may be enlarged, and therefore it is not difficult to distinguish between lung abscess. The bronchoscopy lung biopsy, or cancer cells found in sputum, lung cancer diagnosis has been established.

4, lung cysts secondary infection

Cyst secondary infection, inflammation around the lung tissue is infiltration of cyst-seen, but the inflammatory response relatively light, no poisoning symptoms and a cough more Nongtan. When the infection control, inflammation absorption, should show bright and clean and tidy the cyst wall. For the past X-ray film for the control, diagnosis easier.

The treatment of acute lung abscess is antibacterial and sputum drainage.

Acute bacterial infection of the lung abscess, including anaerobic bacteria, generally sensitive to penicillin, in the course of the patients within one month, the active antibiotic treatment, the cure rate of up to 86 percent. Anaerobic bacteria in the pathogenesis of lung abscess, the only vulnerable Bacteroides not sensitive to penicillin, and the forest lincomycin, metronidazole and clindamycin sensitive. Penicillin under conditions, the general 1200000 -240 000 u / d, serious illness can be 10 million u / d intravenous drip in order to enhance necrosis in the drug concentration. In the treatment of the body temperature normal to normal within 3-10 days and then could be replaced by intramuscular injection. Penicillin effects such as poor, to switch to Lin lincomycin 1.8 g / d intravenous drip, or clindamycin 0.3 g, oral day four times. Metronidazole or 0.4 g, three times daily oral or intravenous injection. If effective antibiotics, continued to 8-12 weeks, until X online empty and the disappearance of inflammation, or only a small amount of residual stability fibrosis.

In systemic treatment on the basis of available local drug treatment with antibiotics such as penicillin 300,000 units used in diluted 5-10 ml saline, to make 4 percent because of Proca, or 2 percent of the Proca for local anesthesia, and then Central nasal catheter or a film infusion of antibiotics to puncture trachea, according to take the appropriate posture abscess site Jingwo one hour, one day. Conditional, may be bronchoscopy in X-ray Perspective, will be fine bronchial tube inserted Vomica close to the drainage bronchial lesions, direct injection of liquid antibiotics.

Expectoration postural drainage is conducive to promote healing, but many of Nong Tan, and physical weakness of the guardianship should be made to avoid large Nongtan emission, the inability to Kechu a result of suffocation.

The positive medical treatment and Vomica can not close the chronic lung abscess, and repeated infection or hemoptysis patients, to be considered for removal; bronchial obstruction of the drainage poor lung abscess, in particular suspected cancer obstruction, or Severe bronchiectasis with hemoptysis who need treatment for, with empyema, or bronchopleural fistula patients, the pumping Nongye, rinse treatment of poor, have also been intercostal incision closed drainage.

Sowing blood of lung abscess, often caused by Staphylococcus aureus, another should be combined blood culture and bacterial sensitivity to the drug for the treatment of sepsis. In addition, it will be actively seized of suppurative lung lesions.

Should attach importance to the mouth, chronic upper respiratory tract infection, to prevent inhalation of contaminated respiratory secretions error, induced by the chance of infection. On the mouth and chest and abdominal surgery cases, we should conscientiously do a good job of meticulous preparation before, during attention to depth of anesthesia, the timely removal of blood clots and oral respiratory secretions, after oral strengthen the respiratory care, such as anti-sedation, analgesia only Cough medicine, respiratory importance of wetlands, diluted secretions, and encourage patients to cough, respiratory aspiration of foreign bodies in a timely manner, maintaining the airway open drainage, so as to effectively prevent the inhalation of respiratory tract infection. Carbuncle positive treatment of skin, boils or purulent lung lesions, do not squeeze carbuncle Boils, can prevent the incidence of blood-borne lung abscess.