The abscess bursts into the chest cavity

Introduction Elderly lung abscess chest pain: inflammatory lesions involving the pleura, increased pain during breathing. If the abscess breaks into the thoracic cavity, it can form empyema, pyo-pneumothorax (pyopneumothorax), or encapsulated empyema due to cellulose wrap, the patient's respiratory movement is limited, and the shortness of breath is aggravated.

Cause

Lung abscess disease is caused by various purulent bacteria, mycobacteria, fungi or parasitic infections. The most common pathogens are anaerobes, such as Streptococcus pneumoniae, Fusobacterium, melanin producing bacteria, Bacteroides fragilis, and purpura. Monocytogenes, etc.; followed by a variety of Gram-negative and Gram-positive bacteria, such as Escherichia coli, Klebsiella, Enterobacter cloacae, F. faecalis, Acinetobacter mobilis, influenza Haemophilus, Haemophilus parainfluenzae, Legionella, Staphylococcus aureus, Streptococcus, Enterococcus faecalis, rare bacteria such as Pseudomonas aeruginosa, Streptococcus pneumoniae, etc.; in addition, some patients with diabetes and immunosuppressive Fungal infection can cause voids, such as Nocardia, actinomycetes; parasites such as amoeba, an important but uncommon pathogen of lung abscess, mainly causing abscesses in the base of the lower lobe; Mycobacteria such as Mycobacterium tuberculosis, Mycobacterium avium, and Mycobacterium intracellularus can also cause lung abscesses. In the lung abscess obtained outside the hospital, anaerobic infection accounts for 60% to 85%, and most of them are mixed infections of several anaerobic bacteria. Recent studies have shown that 10% to 15% of Bacteroides fragilis, 60% of non-fragile bacilli, and 40% of Fusarium can produce beta-lactamase in isolated anaerobic bacteria, thus penicillin-resistant anaerobic Bacterial infection has become a problem that cannot be ignored. In hospital-acquired lung abscesses, often mixed infections of Gram-negative bacilli and positive cocci.

an examination

Related inspection

Drainage tube thoracoscopy

1, symptoms

(1) Onset: Patients with acute lung abscess may have oropharyngeal infections and risk factors for aspiration, or have a history of cold and exertion. The onset can be abrupt, the patient is chills and high fever. After 8 to 14 days, the cavity in the lung is formed. The patient coughs a lot of purulent odor and the body temperature drops significantly. In a few patients, the onset can also be concealed, and fatigue, cough and low fever can last for weeks or even longer. Pulmonary abscess secondary to pneumonia can occur 2 to 3 weeks after the onset of the disease. At this time, the pneumonia should be cured, but it will be hyperthermia, the amount of purulent sputum will increase, and there are often fatigue symptoms.

(2) cough, a large amount of purulent sputum: initial cough mucus or mucopurulent sputum, after 8 to 14 days of pulmonary cavity formation, 40% to 70% of cases coughed up a lot of pus sputum, stinky sputum prompted Anaerobic infection.

(3) hemoptysis: not uncommon, even can cause fatal hemoptysis.

(4) Chest pain: Inflammatory lesions are caused by the pleura, and the pain is aggravated during breathing. If the abscess breaks into the thoracic cavity, it can form empyema, pyo-pneumothorax (pyopneumothorax), or encapsulated empyema due to cellulose wrap, the patient's respiratory movement is limited, and the shortness of breath is aggravated.

(5) Others: fatigue, weight loss, loss of appetite, etc., blood-borne lung abscesses have symptoms caused by the primary disease. Consumption symptoms such as anemia are common in chronic lung abscess and empyema patients.

2, signs of small abscess, deeper parts often have no positive signs; such as large abscess, local can have signs of lung consolidation, such as abscess near the chest wall can appear empty snoring; empyema patients with signs of pleural effusion on the affected side The clubbing can appear within a few weeks of the onset of the disease. Chronic lung abscesses are often seen, sometimes suggesting the possibility of bronchial lung cancer. Blood-borne lung abscess is usually less lung-positive due to small lesions and scattered lesions.

Differential diagnosis

Because the cavity-like lesions in the lungs are found in a variety of diseases, it is necessary to pay attention to the differential diagnosis, mainly:

1. Bronchial lung cancer

Some tumor central tissues may undergo liquefaction and necrosis to form cavities due to insufficient blood supply. Such lesions are mostly single-shot, eccentric, thicker in wall, nodular or irregular in the inner wall, no fluid level, no obvious inflammation around. Sexual infiltration. Patients often have hemoptysis, but no acute infection symptoms, and it is not difficult to identify with lung abscess. The cancerous tissue can also block the bronchial secondary infection, and the distal part forms a lung abscess. In this case, it is especially necessary to distinguish it from the lung abscess. In patients with age >40 years, such as isolated cavity-like lesions in the lungs, attention should be paid. Tumor cytology, fiberoptic bronchoscopy, is of great value for diagnosis. Chest CT can assist with diagnosis.

2, tuberculosis

There are often symptoms of tuberculosis poisoning such as low fever, fatigue, and night sweats. Invasive pulmonary tuberculosis or caseous pneumonia is mostly in the upper lobe with large leaf consolidation. There is a translucent area, which is a wallless cavity, without liquid leveling, and there may be scattered spots on the same side or opposite side. Mycobacterium tuberculosis can be found by smear-resistant acid-fast staining.

3, pulmonary cysts with infection

On the X-ray chest radiograph, the lung cyst is characterized by fluid cyst or balloon swelling. It is round or oval, with clear boundaries. Sometimes there is a gas-liquid plane in the balloon. The cyst can change with the breathing under fluoroscopy. Secondary infections may have high fever, cough and a large amount of purulent sputum, which needs to be differentiated from lung abscess. If the original X-ray is compared, it will be easy to make a diagnosis.

4, lung isolation

It refers to the formation of cystic lung mass by partial lung tissue separation from the lungs due to lung malformation, especially in the intralobular type. The bronchus of the mass can communicate with the bronchial system of the body, often with local secondary infection. Clinical manifestations include cough, cough, hemoptysis, and fever. For example, repeated infections may cause symptoms such as malnutrition and anemia. X-ray showed that the inflammatory infiltration around the cystic cavity was lighter than the lung abscess, mostly in the lower part, and the abnormal arteries from the aorta could be displayed by aortic angiography and magnetic resonance imaging.

1, symptoms

(1) Onset: Patients with acute lung abscess may have oropharyngeal infections and risk factors for aspiration, or have a history of cold and exertion. The onset can be abrupt, the patient is chills and high fever. After 8 to 14 days, the cavity in the lung is formed. The patient coughs a lot of purulent odor and the body temperature drops significantly. In a few patients, the onset can also be concealed, and fatigue, cough and low fever can last for weeks or even longer. Pulmonary abscess secondary to pneumonia can occur 2 to 3 weeks after the onset of the disease. At this time, the pneumonia should be cured, but it will be hyperthermia, the amount of purulent sputum will increase, and there are often fatigue symptoms.

(2) cough, a large amount of purulent sputum: initial cough mucus or mucopurulent sputum, after 8 to 14 days of pulmonary cavity formation, 40% to 70% of cases coughed up a lot of pus sputum, stinky sputum prompted Anaerobic infection.

(3) hemoptysis: not uncommon, even can cause fatal hemoptysis.

(4) Chest pain: Inflammatory lesions are caused by the pleura, and the pain is aggravated during breathing. If the abscess breaks into the thoracic cavity, it can form empyema, pyo-pneumothorax (pyopneumothorax), or encapsulated empyema due to cellulose wrap, the patient's respiratory movement is limited, and the shortness of breath is aggravated.

(5) Others: fatigue, weight loss, loss of appetite, etc., blood-borne lung abscesses have symptoms caused by the primary disease. Consumption symptoms such as anemia are common in chronic lung abscess and empyema patients.

2, signs

Abscess is small, and there are often no positive signs when the site is deep; if the abscess is large, there may be signs of lung consolidation, such as an abscess near the chest wall, which may appear empty; a patient with empyema has signs of pleural effusion on the affected side; It can occur within a few weeks of the onset of the disease. Chronic lung abscess is often seen, and sometimes it is possible to have bronchogenic lung cancer. Blood-borne lung abscess is usually less lung-positive due to small lesions and scattered lesions.

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