Pulmonary infarction is necrosis of lung tissue due to lack of blood flow. The disease is usually caused by an embolism that blocks the pulmonary arteries, resulting in severe chest pain.
What other symptoms? What treatments should you use to avoid the dire consequences that can arise from a relapse?
Pulmonary infarction is necrosis of a more or less extensive fragment of tissue that forms the lungs, caused by insufficient or absent blood supply and therefore lack of oxygen and nutrients.
As a rule, pulmonary infarction is a consequence of embolism, i.e. blockage of the pulmonary artery or one of its branches, caused by a blood clot from the lower extremities. The cessation of blood flow causes tissue necrosis, which will then be replaced by connective tissue (scar).
Let's see in detail what embolism and thrombus are, and therefore what are causes of pulmonary infarction.
Lung ischemia (lack of blood) can be caused by:
Emboli. A collection of materials present in the circulatory system that do not mix with the blood. Can be solid, liquid and gaseous.
Blood clots. A set of blood cells (platelets and red blood cells) and fibrin (a protein that is involved in the blood clotting process). They are formed on trauma, atherosclerotic plaques, from which they are subsequently separated to pass into the bloodstream and transported to the site of obstruction.
Typically, the pulmonary artery is blocked by a blood clot that forms during deep vein thrombosis (blockage of the veins of the lower extremities). Less commonly, a blood clot occurs in the right side of the heart, with atrial fibrillation, heart tumor).
Factors that increase risk of pulmonary infarction may be different.
Congenital factors are associated with problems with genes that control the synthesis of prothrombin (a glycoprotein that affects blood clotting and plays an important role in repairing damaged blood vessels) or lead to a deficiency of antithrombin (a protein that disables blood clotting enzymes).
Other risk factors include physiological conditions and secondary diseases:
Symptoms of pulmonary infarction appear suddenly and are expressed in severe chest pain, which is accompanied by:
If a pulmonary infarction is caused by deep vein thrombosis, the following also occur:
The disease is diagnosed based on an analysis of symptoms and signs, which, as a rule, are quite indicative and require confirmation by a number of diagnostic tests:
Treatment of pulmonary infarction is aimed at:
Patients suffering from a pulmonary infarction are given morphine to relieve pain and given oxygen through a mask.
Then they start drug therapy based anticoagulants, such as heparin, thrombolytic drugs to destroy the blood clot that is blocking the arteries, and antibiotics to avoid possible infections resulting from tissue necrosis.
Sometimes, in cases of pulmonary embolism and the patient cannot take anticoagulants, it is necessary removal of blood clots by endovascular means(insertion of a catheter into an artery).
The mortality rate from pulmonary infarctions, if the patient is in good condition and does not suffer from diseases of the cardiovascular system, is very low. If the patient has cardiorespiratory conditions, the chance of death exceeds 25%.
If a pulmonary infarction is not treated properly, it can have very serious consequences:
Lung gangrene– putrefactive destruction of its parenchyma, which does not have clear anatomical boundaries. Some scientists believe that gangrene is different degrees of the same inflammatory process, others describe lung gangrene as an independent disease.
Etiology and pathogenesis Gangrene is caused by bacteria, the main one being anaerobic streptococcus. Of great importance in the development of gangrene is virulence, the nature of the microflora, the ability to penetrate tissue, as well as to exist and reproduce in a given environment. The inflammatory process and its outcomes depend not only on the microflora, but also on the body’s resistance, reactivity, i.e. immunity. If the body's resistance is reduced, the inflammatory process can progress and cause destruction of the pulmonary parenchyma; with healthy resistance, the lung tissue begins to limit itself from the inflammatory focus.
Microbes that cause gangrene in the lungs enter there hematogenously or bronchogenically, sometimes from neighboring affected organs. Bronchogenic gangrene is observed more often (90%) than others. Its development occurs after anaerobes enter the lungs, which can get there through the respiratory tract.
Predisposing factors for the development of gangrene are previous pneumonia, lung diseases with the subsequent development of bronchiectasis, pneumosclerosis.
Sometimes gangrene is observed in lung cancer, as a result of narrowing of the lumen by the tumor with the further development of gangrene pathogens, because a favorable nutrient environment is created. Some non-pulmonary diseases (diabetes mellitus), trauma, poor nutrition and working conditions (inhalation of dust) also predispose to gangrene. Gangrene of the lung can occur when foreign bodies enter the respiratory tract (tooth fragments, bones), especially in mental patients, drunk people, or during an epileptic seizure.
Gangrene can develop hematogenously with septic diseases of the female genital organs, leg ulcers, gangrenous appendicitis, thrombophlebitis of hemorrhoidal veins. In these cases, pathogens enter the lungs through the bloodstream through the pulmonary artery.
In the affected lungs there are multiple or single gangrenous cavities. The pleura in this area is covered with fibrinous plaque and inflamed. The affected area begins to transform into. Inflammatory infiltration covers a significant part of the lung. The diseased lung has a putrid odor and is dirty green in color.
The lower lobe of the lung is predominantly affected. The disease begins with a rise in high temperature, acute pain in the chest; bloody sputum appears, less often profuse hemoptysis. Shortness of breath and symptoms of general intoxication are observed. The temperature is elevated (39 degrees), of the wrong type, has the ability to decrease as the process dies out, or increase as it spreads. Typically, the temperature subsides after sputum begins to leave the lungs. Sputum is discharged when there is good communication between the affected area and the bronchus. This usually takes several days. It has a very unpleasant putrid smell.
Sputum examination In the vessel, sputum is divided into 3 layers: 1) crumbly sediment on the bottom layer, which consists of pieces of tissue, Dietrich plugs (dense yellowish or dark gray formations), disintegrating purulent cells, elastic fibers, drops of neutral fat, crystals of fatty acids ; 2) the middle layer consists of liquid serous sputum; 3) the top layer is foamy, mucopurulent. The sputum is dirty brown or dirty gray, often chocolate-colored.
Its amount ranges from 300 -600 ml/day. Sputum contains a large number of different microbes (spirochetes, fusiform bacilli, streptococci). The discharge of sputum is usually accompanied by a strong and painful cough; patients tend to take a position so that sputum is not released (semi-sitting - gangrene in the lower parts of the lung, or lying on the sore side - localization of gangrene in the upper parts).
General signs Auscultation reveals sonorous dry, moist rales, crepitus, and amphoric breathing. There are muffled heart sounds. The liver is painful on palpation and enlarged. Hypochromic anemia and leukocytosis are observed in the blood; ROE has been significantly accelerated. Percussion reveals shortening of the percussion sound in the affected area; increased vocal tremors. X-rays reveal the presence of a gangrenous focus in the form of various dark spots, without smooth boundaries, with a cavity in the middle, and the presence of fluid.
Complications Exudative, dry pleurisy (gangrenous, purulent) is observed. Sometimes a gangrenous cavity breaks through into the pleura, pyopneumothorax occurs with sudden acute pain in the side, shortness of breath, heart displacement, a sharp deterioration in general condition, and symptoms of collapse. Profuse, very dangerous bleeding is extremely rare. When a large vessel in the lungs is destroyed, septicopyemia begins to develop. In the chronic form, renal amyloidosis is observed.
Differential diagnosis It is carried out between bronchiectasis, tuberculous cavity, abscess. With a lung abscess, the sputum is purulent, two-layered, and the odor is less offensive. With tuberculous cavity, the sputum has no odor at all and contains tuberculous mycobacteria. The most difficult thing is to differentiate gangrene from bronchiectasis. Here X-ray examinations, anamnesis, and duration of the disease come to the rescue. It is forbidden to perform a puncture of a gangrenous lesion, because it can cause phlegmon of the chest, putrefactive pleurisy.
Strictly bed rest. Using a bronchoscope and catheter, the purulent contents are sucked out, and then antibiotics are administered through the catheter. At the same time, antibiotics are prescribed intramuscularly. Broad-spectrum antibiotics (biomycin, sigmamycin) can be administered. Novarsenol is also prescribed intravenously (3 g of the drug per course). At the same time, there is a decrease in the amount of sputum, its foul odor disappears, and appetite returns. After each infusion of drugs, it is necessary to do urine tests due to the possible development of hematuria, which signals the cessation of further treatment with these drugs. Also, treatment is stopped if hemoptysis occurs. General strengthening treatment is carried out (blood transfusion,).
Sometimes they resort to surgery if there is no improvement after drug treatment. Surgical intervention is also indicated for putrefactive empyema and pyopneumothorax. To avoid further relapses, patients are advised to undergo sanatorium and resort treatment, preferably in areas with a warm climate.
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A lung abscess is an infectious disease. Its difference from other inflammatory processes lies in the formation of a special cavity, where decomposition processes occur together with the destruction of the organ itself.
The disease can be acute or chronic. The first is in the affected area, where ichor is formed and the branches of the windpipe melt and die. When the foul-smelling fluid begins to partially come out with a cough, air accumulates above the formation. Next comes a chronic condition or gangrene of the branch.
In the first form, severe pain in the sternum is observed, which intensifies with coughing and breathing, shortness of breath, dry cough, discharge, foul-smelling sputum, and hemoptysis appear. As the course progresses, the general mood worsens, intoxication, headache, joint weakness, nausea, loss of appetite, and increased fatigue appear. This stage can be identified by visual inspection. Thus, the part of the sternum in which the affected center is located will lag behind when breathing. Sometimes the abscess is localized on both sides simultaneously. Then the movement of the chest will be asymmetrical. Typically, the duration of the acute phase is approximately ten days. But there are other options. It can either drag on (up to three weeks) or end very quickly (within three days).
The second period corresponds to the time of opening of the center cavity filled with pus. The latter confirms the presence of foul-smelling ptism, discharged when coughing. Within a day, up to a liter of liquid is separated. The patient’s well-being improves slightly, as the body’s intoxication decreases and the fever decreases.
An acute process can progress to a protracted stage. In this case, periodic exacerbation of the disease will be observed.
Often bacteria spread through the bloodstream, in which case the list of causes increases, since inflammation is transmitted from any part of the body.
The second factor is considered to be aspiration of vomit in an unconscious state. Often this case occurs in people who are overly addicted to alcohol.
A rare condition of formation is injury.
The main precursor to the progression of the pathology is infection (pneumonia, inflammation of the bronchi, nasopharynx or other adjacent areas).
The onset of the disease depends on the location of the capsule with inflammation. Attaching to the wall of the lung, the deviation progresses vigorously and can lead to serious results, including rupture of the lung tissue.
The second option represents a neoplasm inside the cavity of the respiratory organ. In such a situation, the diagnosis takes place in a hidden form for a long time, practically without disturbing the person. There is a high probability of the disease developing into a chronic form, which manifests itself in the most serious stage.
The pathology develops until the membrane ruptures as a common infection, accompanied by fever, but after spontaneous rupture a purulent cough and excessive expectoration of ptism cannot be ruled out.
It is difficult to diagnose a phenomenon before its dismemberment. When ichor ends up in the respiratory branches, a person experiences the release of copious amounts of fluid. To confirm the diagnosis, the doctor refers the patient to an x-ray pulmonary examination.
To get rid of this disease, radical methods are used. The most accessible treatment is considered to be antibiotic therapy in high doses, bronchial drainage, prescription of drugs to maintain immunity and nutritional correction. In case of the slightest delay in prescribing physiatry, you can get rid of the abscess through surgery, which consists of washing the lung spaces or removing the capsule with purulent contents. It is possible to remove part of the organ if there is no other way to cope with the disease.
If you suspect this pathology, you should contact a specialist in the first few days after the onset of chest pain, cough and fever. Only in such a situation can you get rid of the disease without medical intervention.
One of the most severe complications is purulent bleeding, which manifests itself as a cough of blood and the active spread of putrefactive flow throughout the body, while blood poisoning greatly affects the patient’s well-being and leads to many symptoms, worsening mood and causing new foci of the disease. It will be difficult for a specialist to stop the outbreak.
The most serious complication of this pathology is death.
As preventive measures for the occurrence of deviations, timely treatment of infectious and diseases of the respiratory system, as well as injuries received in this area, should be noted.
With infiltrative pulmonary tuberculosis, the decay phase is a serious pathology, its difference is in its rapid progression. This type of disease is characterized by symptoms of general intoxication of the body, the development of disorders in the respiratory system, up to respiratory failure. Pulmonary tuberculosis in the decay phase is characterized by subsequent decay and disruption of the structure of lung tissue, the alveoli begin to necrotize, and this poses a danger not only to the health, but also to the life of the patient.
Infiltrative pulmonary tuberculosis is a socially dangerous disease. It affects people from 20 to 40 years old, who often live in unfavorable conditions and use alcohol or drugs. Individuals who suffer from infectious chronic diseases are also at risk.
There are certain provoking factors that cause the collapse of the lungs in tuberculosis. The risk of developing lung disease increases in the presence of the following unfavorable conditions:
The pathogen can remain dormant for several years. But with frequent hypothermia, with a weakened immune system or in the absence of a balanced diet, pathogenic microorganisms are activated.
The infectious process in the decay stage resembles the severe stage of pneumonia in its characteristics. As a result of the inflammatory process, infectious agents quickly multiply in the pulmonary space, capturing healthy structures.
The time that a person can live with this disease depends on the timely detection of the pathology and timely treatment. Infiltrative tuberculosis can quickly destroy lung tissue, causing toxic substances to enter the bloodstream. As a result, the following symptoms occur:
With prolonged treatment of the disease, a disseminated phase often develops, which is characterized by the active spread of infectious agents into the cavity of the internal organs. More often, the source of contamination and decay is localized in one lobe of the organ, but the pathological focus does not affect the second.
With infiltrative pulmonary tuberculosis in the decay stage, certain signs appear that are not entirely characteristic of the disease:
Thanks to the use of modern fast-acting medications, it is possible to cure the inflammatory process in the lungs, which is in the seeding phase. The patient's condition improves, unpleasant clinical manifestations are eliminated.
It is important to remember that the effect of taking medications is felt no earlier than two months after the start of complex therapy.
At the same time, it is very important to adhere to all medical recommendations, take prescribed medications, and not deviate from the treatment regimen. With a competent approach, the condition can be normalized, the proliferation of pathogenic microorganisms can be inhibited, this allows the patient to live much longer. Treatment of pathology becomes significantly more difficult if various morphological changes occur in the lung tissues. This complication is caused by the fact that the foci of the inflammatory process begin to resolve, resulting in the formation of a bag that develops into tuberculoma. Treatment for this condition involves surgery.
With the help of modern medications, the positive effect of therapeutic effects occurs within six months.
Nutrition is very important for pulmonary tuberculosis. It is necessary to exclude the following types of food from the diet: salted, smoked, pickled foods, sweets. Include more fresh vegetables, fruits, and berries in the menu. By consuming large amounts of vitamin substances, you can strengthen the body’s natural defense mechanisms, activate the immune system, which will allow the body to more strongly fight back the disease and improve overall well-being.
Read more about nutrition in the article Diet for Tuberculosis.
The following types of medications are prescribed:
If conservative treatment is ineffective, the doctor considers the advisability of surgical intervention in which intrathoracic lymphatic formations are removed. Additionally, a procedure may be prescribed to remove fluid or pus from the pleural area. It is indicated in case of slow resorption. After removing the contents, the cavity is washed with medications.
Inflammatory processes in the body under certain conditions tend to progress. Infections penetrate various tissues by hematogenous, lymphogenous and bronchogenic routes. As a result, areas of inflammation can arise even in foci remote from the primary affect. Diseases caused by anaerobic microflora are considered especially dangerous. They are often complicated by tissue suppuration and the development of gangrene. This is a severe pathological process related to types of necrosis. It is characterized by complete tissue necrosis and rapid spread to nearby areas. One of the most severe pulmonary diseases is gangrene of the lungs. It leads to the destruction of the respiratory organs and the development of multiple organ failure.
Lung gangrene is a disease characterized by the occurrence of a purulent-destructive process that covers a large area of the organ parenchyma. The pathological focus is not limited to the capsule or healthy tissue. This is how it differs from an abscess. Gangrene is a type of necrosis - the death of cells that make up an organ. The disease often occurs against the background of inflammatory processes in the lungs, including abscess, phlegmon, pneumonia, etc. In most cases, the pathology is diagnosed in middle-aged and elderly men.
Lung gangrene is characterized by a serious condition of the patient. Symptoms of the pathology include fever, development of shortness of breath and cough, and the release of large amounts of purulent sputum. The patient's condition rapidly deteriorates, often developing severe complications against the background of gangrene. Treatment is carried out in a hospital setting by pulmonologists and thoracic surgeons.
Why does lung gangrene develop? The etiology of this disease varies. The most common cause of necrosis is contamination of the lung with anaerobic microorganisms. Less commonly, gangrene develops as a result of infection with nonspecific bacteria that cause various inflammatory processes. The following microorganisms can cause pathology:
Bacteria penetrate into lung tissue in several ways. Often the spread of infection occurs due to a breakthrough of the focus of purulent infection. In the presence of pathological processes such as severe pneumonia, bronchiectasis, advanced forms of tuberculosis, the likelihood of developing gangrene increases. In addition, risk factors include alcoholism, smoking, drug addiction and diabetes. The reasons for the entry of bacteria into the parenchyma of an organ can be hematogenous and lymphogenous spread of infection from other foci, chest trauma and surgical interventions.
The mechanism of development of lung tissue necrosis depends on the etiology of the disease. Bronchial obstruction can contribute to the occurrence of gangrene. Due to the narrowing of the airway lumen, the protective mechanism is disrupted. The cilia located on the inner surface of the bronchi cease to function normally. As a result, the cleansing function of the respiratory tract, carried out by coughing, is suppressed. In this case, the infection can enter the lungs through the bronchogenic route.
Less commonly, the infectious process develops as a result of hematogenous introduction of bacteria. This happens with serious inflammatory pathologies. Among them are bacterial endocarditis, osteomyelitis, thrombophlebitis, etc. The infection spreads through the lymphatic vessels in severe tonsillitis and mediastinitis. This variant of the development of the disease is the least common.
One of the links in pathogenesis is aspiration. This process means that infected particles are thrown into the bronchi. Aspiration often occurs in patients suffering from alcoholism, bedridden patients, and people who have gastroesophageal reflux. Gangrene can develop with penetrating wounds to the chest. In this case, in addition to damage to the lung tissue, inflammation caused by anaerobic microflora is often associated. Having penetrated the parenchyma, bacteria quickly multiply and enter the bloodstream. This causes activation of inflammatory mediators, resulting in increased breakdown of lung tissue. Increasing intoxication leads to a deterioration in the patient’s general condition and prognosis of the disease.
In the pathogenesis of lung gangrene, the state of the body's immune forces is of great importance. With normal functioning of protective mechanisms, this disease develops extremely rarely. Most often, pathology occurs against the background of weakened immunity.
Depending on the method of penetration of bacteria into the respiratory system, bronchogenic, hematogenous, post-traumatic, lymphogenous and thromboembolic gangrene of the lungs are distinguished. There is also a classification based on the spread of infection. Based on this criterion, the following are distinguished:
If 1 segment of the lung is affected, the disease is classified as an abscess. In turn, bronchogenic necrosis is divided into aspiration, post-pneumonic and obstructive gangrene. In addition, the disease is divided into stages of destruction. According to the classification, atelectasis-pneumonia, necrotic changes in the organ parenchyma, sequestration and purulent fusion are noted. The last stage is otherwise called gangrene itself. It means the complete destruction of lung tissue with a tendency for the process to spread.
“Lung gangrene” is a diagnosis that is made on the basis of a morphological study of foci of destruction. The formation of necrosis occurs sequentially. At the initial stage, there is a thickening of the lung parenchyma area - an inflammatory infiltrate. In the absence of treatment, the lesion is delimited from the surrounding healthy tissue. From the central part of the infiltrate, purulent melting of the inflamed area begins. A cavity is formed in this place. With normal immunity, an abscess capsule forms, which is gradually covered with scar tissue. The cavity becomes epithelialized over time.
If the body's defenses are reduced, then an abscess capsule does not form; instead, the focus of destruction quickly spreads throughout the lung tissue. The entire parenchyma becomes compacted and edematous. Foci of purulent melting undergo necrosis and can merge with each other. As a result, sequestra are formed - cavities filled with purulent contents. With timely treatment, the destruction of lung tissue stops. Areas of necrosis (gangrene) are delimited. A morphological picture characteristic of an abscess is observed.
There are no specific criteria for diagnosing lung gangrene. The symptoms of the disease are similar to those of various acute pathologies of the respiratory system. These include:
On auscultation, moist rales and areas of amphoric breathing and crepitus are heard. With massive gangrene, the patient takes a forced position - on his side. There is a lag of one half of the chest in the act of breathing, tachypnea and an increase in heart rate.
Lung gangrene is a serious pathological condition that threatens with serious consequences. Complications of the disease include: sepsis, infectious-toxic shock, pleural empyema, DIC syndrome, pericarditis. In some cases, pulmonary hemorrhage develops.
Every doctor should know how lung gangrene is detected. Diagnosis of the disease is based on anamnesis, complaints, and auscultation. If gangrene is suspected, a chest x-ray, puncture of the pleural cavity, and sputum examination are performed. Radiation research methods reveal areas of darkening in the lung - decay cavities. Leukocytes, red blood cells, and particles of destroyed organ tissue are found in the sputum. It is necessary to study the exudate to determine sensitivity to antibiotics.
If a disease is detected, the patient should be urgently hospitalized. Detoxification, desensitizing and antibacterial therapy is carried out. What drugs are prescribed if an abscess and gangrene of the lung develop? Treatment begins with 2 broad-spectrum antibiotics. The drugs used are Ceftriaxone, Ciprofloxacin, and Amoxiclav. In addition, oxygen therapy, plasmapheresis, bronchoalveolar lavage, and aspiration of pus are indicated. If conservative treatment methods do not help, surgery is performed - lung resection, lobectomy or pneumonectomy.
What is the prognosis if lung gangrene develops? The classification of pathology is of great importance. With limited necrosis and the initial stages of the destructive process, complete recovery is possible. The spread of gangrene is an unfavorable sign. With severe necrosis of lung tissue, death is possible in% of cases.
There is no specific prevention of lung gangrene. The risk of developing necrosis is minimal in people who do not have bad habits and chronic pathologies of the respiratory system. For the purpose of prevention, one should strengthen the immune system, lead a healthy lifestyle, and also sanitize any foci of inflammation present in the body.
Lung abscess is a purulent process in the lung tissue.
The decomposition of lung tissue, which occurs under the influence of pus, is called a lung abscess. The causes of a lung abscess can be the activity of pathogenic microorganisms and the entry of objects into the lung. There are frequent cases when the infection can enter the lungs from the maxillary sinuses or tonsils, from a boil on the face or an abscess in the mouth. If a malignant tumor has decomposed in the lung, then such a process can also provoke an acute lung abscess.
In acute lung abscess, severe pain in the chest area occurs. Acute lung abscess usually resolves with hemoptysis and shortness of breath. There is also a severe cough that produces purulent sputum. Sometimes the patient begins to feel unwell after the abscess cavity in the bronchi breaks through. A large amount of sputum may be discharged, which has a putrid odor.
Lung abscess often develops as an acute disease, but the process then often follows the path of a chronic process. Exacerbations and remissions provoke chronic lung abscess. During this period, the patient exhibits signs of acute lung abscess, but during remission, chest pain decreases, but the amount of purulent sputum increases. A barking cough and severe night sweats may occur, and the patient begins to become very tired.
In the development of a lung abscess, factors that reduce the defenses of the human body often play a role. Such factors create conditions for pathogenic microflora to enter the respiratory tract. Such factors include alcoholism and drug overdose. Surgical interventions using general anesthesia, prolonged vomiting and neurological disorders have an impact. Many diseases can also be factors contributing to the appearance and development of a lung abscess. These are, first of all, epilepsy, tumors in the lungs, foreign bodies caught in the respiratory tract, gastroesophageal reflux, diabetes mellitus and operations on the esophagus and stomach.
Successful treatment of a lung abscess depends on early diagnosis of the disease and timely treatment. To do this, an accurate diagnosis must be made by specialists in modern diagnostic laboratories, where there can be no error. Treatment of a lung abscess, depending on the phase of its development, can be conservative or surgical. The current use of broad-spectrum antibiotics when starting treatment in an early phase is successful in treating a large percentage of patients with acute lung abscess. With such a diagnosis confirming a superficial abscess, treatment is carried out on an outpatient basis.
When a diagnosis is made, confirming that the patient has a lung abscess not at an early stage or lung gangrene, the main indicator of treatment is surgical intervention in which the purulent cavity is opened. Patients must be admitted to the surgical department. After opening and removing a lung abscess, the patient needs proper nutrition, blood transfusions and blood substitutes. Antibiotics should be used carefully, taking into account the patient's individual sensitivity to them. Treatment of a lung abscess also involves the use of specific therapy. This is the use of gamma globulin and staphylococcal toxoid. Sometimes the patient undergoes correction of impaired metabolism.
Timely detected acute lung abscess has a favorable prognosis for treatment. This is true when the diagnosis is made absolutely accurately by doctors using modern medical equipment. All necessary modern drugs are also used to treat lung abscess. Surgery performed late may lead to the development of chronic lung abscess or lung gangrene. The qualifications of the personnel, the degree of development of inflammation and the individual characteristics of the patient’s body also play an important role in the favorable outcome of treatment. The patient should know that postoperative care is important, as well as compliance with all doctor’s instructions for a long time after surgery, as well as taking all prescribed medications. After discharge from the hospital, the patient must be observed by a pulmonologist at his place of residence. After three months, the patient must undergo a control x-ray examination.
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Lung gangrene is a pathology that is characterized by decomposition (“rotting”) of lung tissue under the influence of microbes of various origins. Unlike a lung abscess - a putrefactive decay that has more or less defined boundaries - gangrene covers large areas and tends to spread to healthy lung tissue. More often, the pathology is diagnosed in middle-aged men, 2/3 of whom are addicted to alcohol-containing drinks. In children, such destruction occurs in isolated cases, as a complication of pneumonia.
Gangrene of the lung - the image shows a cavity with uneven edges
The main causes of lung gangrene are as follows:
The symptoms of lung gangrene are similar to the symptoms of an abscess, but they appear more acutely.
Includes examination of the patient, X-ray and ultrasound examination of the lungs, laboratory tests (urine and blood tests, determination of the properties and amount of sputum). In case of gangrene, pleural puncture (removal of fluid from the cavity around the lung with a needle) is contraindicated due to the risk of inflammation of the pleura.
The image shows extensive darkening with jagged edges and uneven density across its entire surface. X-rays are repeated over several days to monitor the dynamics of the spread of necrosis. The dynamics of the process is also monitored by bronchoscopy (a special flexible instrument (endoscope) is used to penetrate the lumen of the bronchi and trachea through the mouth). Ultrasound examination shows the presence and volume of fluid in the pleural cavity.
When examining urine, a protein content is revealed, which should not be present, and an increased content of cylinders (normal: 1-2 cylinders). Biochemical and general blood tests reveal a number of leukocytes that is significantly higher than normal.
Treatment of lung gangrene should only take place in a hospital setting. Intensive complex therapy is carried out, including: restoration of the body’s protective functions and homeostasis (constancy of the body’s internal environment), impact on the source of infection and the fight against infection in general.
From the very beginning of treatment, detoxification and desensitizing (intravenous administration of antiallergic drugs) therapy is carried out. Antibacterial therapy consists of using at least two antibiotics (2nd generation cephalosporins) within limits several times higher than therapeutic ones. Simultaneously with antibacterial therapy, bronchial drainage is performed (cleaning the bronchi with a special instrument).
If conservative measures are not effective, surgical intervention is indicated, consisting of complete or partial removal of the infected lung.
The only cause of lung gangrene, i.e. necrosis and putrefactive decomposition of lung tissue, is penetration of putrefactive bacteria into them. It is very common to inhale air containing such bacteria, but the normal body has the ability to destroy and render them harmless. However, under certain conditions, they become fixed and destroy the lung tissue, which, precisely due to the presence of specific putrefactive bacteria, undergoes a kind of putrefactive decomposition.
Most often, the reason for the development of pulmonary gangrene is the penetration of organic foreign bodies, namely food particles, into the lungs. In this case, putrefactive bacteria either enter the lungs along with a foreign body, or only subsequently penetrate this latter and first cause putrefactive decomposition of this body, and then of the adjacent lung tissue.
Most symptoms of pulmonary gangrene are directly related to local lung disease. The characteristic properties of sputum in themselves are decisive for the diagnosis.
infecting everything around.
In some cases, with pulmonary gangrene, it can lead to ulceration of blood vessels and severe hemoptysis.
All other lung symptoms are not characteristic of gangrene. Most patients complain of cough, colic in the side and more or less severe shortness of breath. Physical examination usually helps to determine the location of the gangrenous nest, since physical symptoms depend entirely on the location and extent of the gangrene.
As for the general course of the disease, extremely large differences are observed in this regard. In those cases in which pulmonary gangrene develops secondary to other diseases and the clinical picture of the disease depends on the underlying disease.
The prognosis depends, first of all, on the existing underlying disease, but otherwise - on the extent of the lesion, on the patient’s state of strength and on the possibility of proper care and treatment. If the process in the lungs is limited, then significant improvement can occur even in very severe cases. However, you should always keep in mind the possibility of a return.
Under the influence of pathogenic microorganisms on the lung tissue, it is destroyed. This is how a lung abscess and a more severe form of infectious destruction—its gangrene—occurs. These diseases are accompanied by necrosis of the pulmonary area and its collapse.
A lung abscess is a formation in the form of a cavity, usually round in shape, filled with purulent contents. It is surrounded by a membrane consisting of connective tissue fibers and impregnated with immune cells and blood proteins of the lung area.
Lung abscesses
A much more serious condition is lung gangrene. It is accompanied by rapidly spreading tissue necrosis and is not delimited from healthy areas.
Gangrenous abscess is an intermediate variant between these two conditions, tending to be separated from normal tissue.
These diseases occur predominantly in males aged 20 to 55 years. The frequency of the disease has decreased significantly over the past decades, but the mortality rate remains quite high - up to 10%. If gangrene is caused by Pseudomonas aeruginosa, Klebsiella or Staphylococcus aureus, the incidence of adverse outcomes increases to 20%.
Smoking is a risk factor for lung abscess
Conditions that increase the risk of lung abscess or gangrene:
Infectious destruction of lung tissue occurs in severe neurological diseases (consequences of stroke, myasthenia gravis, amyotrophic sclerosis), with prolonged vomiting, epileptic seizures, and a foreign object in the bronchi. Risk factors include any operation under general anesthesia, as well as drug use. Finally, the penetration of microbes into the lungs is facilitated by stomach diseases, accompanied by the reflux of its contents into the esophagus, or, for example,.
Germs usually enter the lungs through the upper respiratory tract. Often their source is in the nasopharynx, for example, with tonsillitis. Very often, microbes are inhaled along with microscopic particles of stomach contents after vomiting or gastroesophageal reflux. The disease often occurs when there is a bruise or wound to the chest.
Microorganisms that enter the alveoli cause an inflammatory reaction, which is accompanied by increased penetration of immune blood cells into this area. Leukocytes actively destroy pathogens, forming enzymes that destroy proteins and pus. The resulting cavity is surrounded by a dense cell wall.
After 15–20 days, the abscess opens into the nearest bronchus and empties. The cavity collapses, leaving behind a focus of compacted (sclerosed) lung.
Gangrene develops faster. As a result of circulatory disorders, the active action of pathogens causes inflammation to not be limited, and a large area of necrosis of the lungs occurs. Here, many disintegrating foci are identified, some of which are emptied through the bronchi. During gangrene, a large amount of toxic metabolic products enter the blood, causing severe intoxication (poisoning) of the body.
The disease is usually preceded by. An abscess forms within 14 days.
Signs of the disease before the abscess empties:
After the abscess empties, which occurs on days 4–12 of illness, the following appears:
If the abscess cavity is poorly cleaned, the following symptoms develop:
Lung gangrene is accompanied by similar, but more pronounced symptoms:
The disease is diagnosed by a therapist or pulmonologist, taking into account the conditions preceding the disease, the duration and severity of symptoms. Since destruction of lung tissue is often found in pneumonia, the doctor must regularly and carefully perform percussion and auscultation in order to suspect the disease in time and refer the patient for additional diagnostics.
Blood analysis:
Large lung abscess with fluid level
Lung abscess must be distinguished from the following diseases:
Therapy is carried out only in a hospital.
The food is high in calories and high in protein. Fat should be limited slightly. Very useful for patients:
Salt and liquid intake should be slightly reduced.
The basis of treatment is . The duration of their use reaches 2 months. First, antibacterial drugs are prescribed empirically. These are modern inhibitor-protected penicillins, such as amoxicillin and clavulanic acid.
Second line agents:
Once sensitivity results are obtained, the regimen can be adjusted. First, the drugs are administered intravenously, then in tablets.
Detoxification is prescribed using intravenous solutions, symptomatic drugs (antipyretics, vitamins, restoratives).
The abscess can be drained during bronchoscopy, and it can also be punctured through the surface of the chest, using ultrasound or radiography for control.
Vibration massage and postural drainage are prescribed.
Surgical intervention is performed in 10% of patients. Indications:
Depending on the size of the pathological focus, the corresponding part of the lung or the entire organ is removed.
After discharge, the patient is observed by a pulmonologist. A control x-ray is prescribed 3 months after recovery.
Simple breathing exercises
At home it is necessary to carry out breathing exercises. Among folk remedies, one can note the effectiveness of honey and beekeeping products. Inhalations with garlic juice, essential oils of eucalyptus and pine are also useful. It is recommended to use infusions of chamomile, linden blossom, raspberry, and rose hips.
After a lung abscess, recovery occurs in 60–90% of cases. In 15–20% of patients, a chronic abscess develops. Mortality does not exceed 10%. With severe gangrene of the lung, unfavorable outcomes are recorded in more than 40% of cases.
To avoid such a serious disease, prevention is necessary to eliminate risk factors. They are listed in the corresponding section of our article.
Abscess and gangrene of the lung are two interrelated processes ( the second follows the first). A lung abscess is a severe suppuration that occurs in the area of the air breathing organ, where a whole bag is formed filled with purulent deposits.
Lung gangrene is a powerful and rapid death of lung tissue, their decomposition due to a pulmonary abscess. Gangrene is characterized by the absence of a clearly visible line between healthy and dying organ tissues.
The main cause of lung gangrene is the entry of harmful microbes into the respiratory organs and bronchi.
They can get there in various ways:
Lung gangrene is a serious disease, complications often occur, and death is possible.
To create the correct treatment structure, you must first conduct a certain laboratory and instrumental analysis of the body.
First of all, the doctor prescribes an examination for the patient in the laboratory, where they will do the following:
1. General blood test: they will look at the shift of rods and nuclei, the level of hemoglobin, whether the erythrocyte sedimentation rate is increased, whether there is leukocytosis, whether neutrophil grains are toxic, whether their number is increased.
2. Biochemical blood test: they will note whether there is a noticeable increase in the number of fibrin, alpha globulins, gammaglobulins, sialic acids, haptoglobin, and whether the number of albumins is below normal.
3. General urine test: look for leukocytes.
4. They will analyze the sputum that comes out: the discharge is dirty and gray in color, three-layered (watery on top, slightly white, a little foamy; mouse-colored in the middle; pus and pieces of lung tissue are already coming from below). Elastic fibers may appear.
When the abscess ruptures, the body temperature drops, and copious discharge of foul sputum begins. There is such an unpleasant smell because there is a purulent process going on.
If proper drainage is carried out, the liquid will be visible only at the bottom of the bag or will disappear completely.
Using this procedure, you can easily find the specific place where the bag formed. Among other things, it is possible to notice a certain level of wateriness, dead areas of the epithelium, and understand how much the film enveloping the respiratory organs and the chest wall is involved.
It is on computed tomography that the most accurate number of sequesters can be detected.
Video - What is a lung abscess?
Many experts believe that this study should be carried out obligately only in cases of preparing the patient for surgery and to carry out a medical and social examination of recovery.
This procedure is carried out not only when examining a patient, but also when treating him. Removing purulent deposits greatly helps the patient, they also serve as a source of microflora recognition. Based on the data obtained, the degree of resistance and response to the necessary antibiotics is determined.
Especially in the case of a powerful, sudden entry of microbes and toxins into the blood at one time, this can give rise to bacteremic shock ( almost always ends in the death of the patient).
For gangrene of the lung, pulmonologists and thoracic surgeons are involved in treatment (although not for the entire period of therapy).
The treatment plan always goes like this:
The main goal of doctors is to combat toxins that poison the body, as well as restore water and electrolyte balance. For this purpose, blood plasma, plasma and protein replacement solutions, and water-electrolyte mixtures are injected into the veins. No less popular are vitamins, products that help to establish the process of self-regulation of the immune system, and drugs that support the functioning of the heart muscle and blood vessels.
If the described conservative treatment is carried out quickly and strictly directed, it will help to contain and localize the destruction of the respiratory organ.
If such therapy does not help, another level of intervention is necessary - surgical, including pneumonectomy/lobectomy/pneumotomy/bilobectomy.
Below will be listed the basic medications used for gangrene of the lungs. As with any medical condition, you should consult a qualified professional before using any of them, as some medications may not be suitable for your individual needs, some may have unwanted side effects, etc.
1. Tienam.
Dosage rules: the degree of disease determines the portion per day and method of application. The portion is divided into several identical parts, which are supposed to be taken in one day. The dose depends on a number of factors: on the performance of the kidneys, on body weight, on how sensitive the microorganisms are.
Intravenous administration of the drug is better in the initial stages of blood infection with bacteria, inflammation of the inner lining of the heart and other complex, deadly infections, including infection of the lower parts of the respiratory tract.
Adults need to inject one or two grams three to four times a day. The daily serving limit should not exceed four grams ( fifty milligrams per kilogram).
The drug is administered over twenty to thirty minutes ( dose size is less than five hundred milligrams) or forty to sixty minutes ( dose size exceeds five hundred milligrams). If the patient feels nausea during the procedure, the medicine should be infused more slowly.
2. Cefepime.
Dosage rules: the drug is administered intravenously for at least thirty minutes.
If the patient has pneumonia due to harmful gangrene bacteria, one or two grams are injected every twelve hours for ten days. If the patient has so-called neutropenic fever, he should receive two grams every eight hours for a week or until the pathology is eliminated.
3. Fluconazole (antifungal agent).
Dosage rules: the medicine is administered intravenously using a dropper (the rate should not exceed two hundred milligrams per hour). The size of the dose of medication per day is determined by the nature and severity of the resulting fungal infection.
If a decision is made to take the drug not intravenously, but orally, the dose does not need to be changed.
It is worth noting that this product can be combined with other solutions.
For inflammation and suppuration, as a rule, about four hundred milligrams per day are dripped.
4. Human immunoglobulin is normal.
Dosage rules: the drug is administered intravenously. For an adult, use an undiluted product in the amount of twenty-five to fifty milliliters through a dropper; the rate of administration should not exceed forty drops per minute.
The course of treatment contains from three to ten procedures every one to three days.
5. Ambroxol.
Dosage rules: this drug is used in the form of inhalations (one milliliter equals twenty drops). Adults and children over twelve years of age receive four milliliters (thirty milligrams) three times a day for the first two or three days. Afterwards, the serving size of the medication is reduced to four milliliters twice a day.
It is important to remember: when taking the medicine by inhalation, you must use a special device, having first read the instructions.
You need to drink a lot of water while taking the medicine..
6. Sodium acetylcysteine.
Dosage rules: the drug is used intravenously or intramuscularly.
It is administered intravenously only in a hospital under the supervision of doctors, if it is not possible to take the medicine orally. The first portion is a 1:1 proportion of the drug and sodium solution (0.9%)/glucose solution (5%). The drug should be administered slowly (about five minutes).
When administered intramuscularly, the medicine must penetrate deep into the muscle.
For adults, the dose is three hundred milligrams (three milliliters) once or twice a day. In general, you should get three hundred to six hundred milligrams of the drug per day.
You need to drink a lot of water.
Prevention measures include increasing medical education among the people, eradicating bad habits, improving people’s quality of life, and providing timely medical care when inflammatory, purulent, and infectious diseases are detected.
