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Purulent diseases of lungs and pleura

Ihor Vynnychenko,

Head of Surgery and Oncology

Department SumDU

Lung abscesses

•Lung abscess - necrosis of the pulmonary tissue and formation of cavities containing necrotic debris or fluid caused by microbial infection.

•Necrotizing pneumonia

•Lung gangrene

Factors contributing to lung abscess

•Oral cavity disease

•· Periodontal disease

•

·

Gingivitis

•

Altered consciousness

•

·

Alcoholism

•

·

Coma

•

·

Drug abuse

•

·

Anesthesia

•

·

Seizures

Factors contributing to lung abscess -2

•Immunocompromised host

•· Steroid therapy

• · Chemotherapy

• · Malnutrition

•· Multiple trauma

•Esophageal disease

• · Achalasia

•· Reflux disease

•· Depressed cough and gag reflex

•· Esophageal obstruction

•Bronchial obstruction

• ·

Tumor

•· Foreign body

•· Stricture

Lung abscessess classification

Duration:

•Chronic

•Acute (4-6 weeks)

Etiology (Anaerobic bacteria)

Origin:

•Primary (infection +aspiration or pneumonia)

•Secondary (obstruction, spread from extrapulmonary site, immunocomprimized

Classification According to the character of purulent process:

•single purulent abscesses;

•- multiple purulent abscesses;

•- bilateral purulent abscesses;

•- gangrenous abscesses (single, multiple, uni- and bilateral);

•- limited gangrene;

•- wide-spread gangrene.

•

Classification According to stages:

•- 1 stage - necrotic pneumonia;

•- 2 stages - destruction and rejection;

•- 3 stages - cleaning and cicatrization.

Classification Complications:

-

•pulmonary bleeding;

-

pyopneumothorax;

-

pleural empyema;

-

sepsis;

-

bronchogenic dissemination.

Symptomatology

•Depends on:

•on the size of the focus and

•character of destruction,

•reactivity of the organism and

•stage of the disease,

•peculiarities of the drainage of purulent cavities and

•complications.

Clinical manifistation of the first stage of acute abscess

•general weakness,

•headache,

•malaise,

•suppressed appetite,

•moderate chest pain,

•dyspnea,

•subfebrile temperature