Lung abscess is a circumscribed lump of lung tissue. Abscess cavities form, which almost always have purulent contents. There are different causes for this, usually in connection with infections.
Causes are usually severe pneumonia, pulmonary infarction, aspiration of purulent secretions (eg from purulent tonsillitis), emphysema, bronchiectasis, bronchial carcinoma with tumor breakdown, after accident with accompanying spit or perforation of lung components. In addition, abscesses that are located just below the diaphragm (subphrenic) and spread through the diaphragm can lead to lung abscess.
Scattering of purulent infections via the bloodstream, or the lymphatic system can also lead to this serious clinical picture. Particularly at risk for lung abscesses are persons who have a poor and weakened immune system. Worth mentioning are particularly thin people, malnourished patients or tumor patients. The pathogen spectrum that leads to a lung abscess consists mostly of staphylococci or pneumococci.
For more information on lung abscess, see the main article abscess.
Lung abscess may be completely symptom-free or may be associated with severe symptoms of infection.
The abscess itself, when encapsulated by the pleura and the airways, can grow slowly and remain unhindered, but the symptoms are primarily triggered by the underlying cause. In most cases, persistent pneumonia is behind with the following symptoms:
The abscess may grow slowly toward the bronchi or pleura.
If he gets into these structures, there may very suddenly be shortness of breath, coughing, severe breathing pain and other symptoms. These symptoms are accompanied by strong halitosis. A renewed inflammation of the pneumonia, a Pleuraempyem, as well as a bloody expectoration can be the consequence. If the lung abscess without concomitant disease over a longer period of time, mild so-called B-symptoms can draw attention to the disease. These include fatigue, paleness, weight loss, nocturnal sweating and loss of appetite.
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The diagnosis of lung abscess can often be made after the clinical picture. Proof are then X-rays of the lungs. A computed tomography then shows a precise course of the abscess cavity. The blood count shows an increase in the inflammatory values, such as CRP value, leukocytes and an infectious anemia. If the abscesses of the lung have already been tunneled, bronchoscopy may represent the process of abscess.
Lung abscess may develop as a result of bacterial infection, such as pneumonia. The pathogen detection is done by examining a blood sample or by diagnosing the sputum (ejection).
Typical pathogens that cause lung abscess in pneumonia are pneumococci, streptococci, pseudomonas, legionella or klebsiella.
Lung abscesses can also occur when bacteria from the mouth and throat were inhaled with the pharynx and increased in the lungs. These pathogens are mostly anaerobic bacteria that do not require oxygen for their growth, such as Becteroides, Peptostreptokokken or Fusobacterium. Also mixed infections with aerobic and anaerobic bacteria as well as an additional infestation with fungi or worms are possible with lung abscess.
As an alternative to an x-ray thorax, a CT scan of the lung can be made to diagnose or secure the findings. By CT, the lung tissue can be precisely displayed and other diseases that also manifest as round herds in the lungs (eg tuberculosis or bronchial carcinoma) are excluded.
The conservative treatment of lung abscess consists in the antibiotic treatment as well as in the repeated bronchoscopic suction of the pus. Also, a so-called vibration massage can lead to accelerated dissolution of the secretion. In case of failure of the conservative therapy usually the surgical therapy has to be used, which consists of the surgical opening of the abscess cavity and the following evacuation or suction. Thereafter, a wound drainage is inserted and the abscess cavity is rinsed regularly. Very large abscesses or chronic abscesses usually have to be removed completely surgically, which often means the removal of a whole lung section.
The treatment of a lung abscess takes place by means of antibiotic therapy. For this purpose, it is necessary to determine the pathogen by a microbiological examination of the blood or sputum (ejection). The antibiotics are chosen to cover a broad spectrum of activity and are effective against both aerobic bacteria (oxygen-requiring bacteria) and anaerobic bacteria (bacteria that can live without oxygen).
In lung abscess, clindamycin is usually given in combination with cefotaxime or ciprofloxacin. Depending on the severity of so-called beta-lactam antibiotics such as ampicillin, piperacillin or amoxicillin can be used to control the pathogens. The antibiotic therapy takes place in the first days via an infusion and then in the form of tablets. The entire treatment with antibiotics takes several weeks until the abscess has completely receded.
As a rule, a lung abscess is treated non-surgically, ie conservatively. This antibiotics are used. In addition, a bronchoscopy is often performed in which the abscess cavity is evacuated and a cytological specimen is usually taken in order to rule out a malignant ( malignant ) process. As a rule, these two measures are sufficient to heal a lung abscess, even if the healing process sometimes extends over a longer period of time.
In rare cases, however, it can happen that a lung abscess under antibiotic and bronchoscopic therapy can not be cured. The Ultima ratio is then the operation, in which the proportion of the lung, in which the abscess sits, must be removed. As little lung tissue as possible is removed. Rarely, due to the size or location of the abscess, a whole lung lobe must be resected.
Complicated courses of a lung abscess exist in a lasting Fistelbildung (particularly with chronic abscesses) and in a breakthrough into the lung tissue. Severe cases can be septic, ie with life-threatening concomitant symptoms that can lead to death. Another serious complication is the gangrene of the lung tissue, ie the death of entire lung sections. This occurs especially when abscesses are detected late and treated surgically, or when it comes to recurring abscesses in the lungs.
A pleural empyema is a collection of pus between the two leaves of the pleura.
The pleura consists of a leaf that envelops the lungs directly and a leaf attached to the chest from the inside. In this room there is a negative pressure, as well as small amounts of a lubricating fluid to facilitate the rubbing of the leaves during breathing. In the course of pneumonia and lung abscess, inflammation and involvement of the pleural leaves may occur. As a result, liquid pus may get between the pleural leaves and cause empyema, a form of pleural effusion. This can be very painful and hinder breathing. As a rule, the pus must be drained with drainage until the inflammation has subsided.
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A lung abscess is basically curable and the lethality is low. How fast or how well the abscess heals depends not only on the treatment method, but also on the size of the place of inflammation and the number of abscesses.
Treatment is with antibiotics, with the development of antibiotic resistance being a potential complication here. If the antibiotic therapy does not work, the abscess may also be drained by drainage. In severe cases, it is also possible to remove part of the affected lung (segmental or lobectomy).
Lung abscesses show a very different prognosis, depending on their cause, the underlying pathogen, the physical condition and the course of the disease.
If a small abscess occurs as a result of pneumonia in an immunogenic person, the disease can usually be cured easily with the help of short antibiotic therapy. Aggressive pathogens, large abscesses, immune deficiencies and comorbidities increase the risk of complications and dangerous processes.
Even if the abscess heals, there may be permanent fistulas in the lungs, adhesions to the pleura, and damage to parts of the lung tissue. Before this happens, a small part of the lung can be surgically removed as the last therapeutic measure. Overall, the prognosis can be improved in particular by the timely and sufficient treatment of pneumonia and its concomitant symptoms.
If a roundish structure in the region of the lung tissue is recognized in the radiological picture of the lung, a tumor must always be excluded from a diagnostic point of view, even if in most cases it is inflammation, abscesses or other lung diseases.
Important signs that indicate an abscess are concomitant or previous pneumonia. Even an existing fever and cough first speak for a lung abscess, even if this may also be symptoms of advanced lung tumor. The most important means of distinguishing both diseases is the determination of the pathogen. First, an attempt is made in the laboratory to determine a pathogen from the ejection of the cough. A puncture of the abscess is also possible. In the laboratory, it is then easy to determine whether it is a pathogen-related inflammation or tumor tissue.