Definition
The lung abscess is a cavity containing pus, located in the lungs; this lesion is typically surrounded by a more or less extensive inflammatory area.
Usually, the lung abscess is caused by an infection sustained by particularly aggressive microorganisms, which manage to reach the lower airways. This process can be secondary to the inhalation of secretions from the oropharynx, in subjects who, for whatever reason, have temporary or permanent difficulties in swallowing (eg neurological disorders, alcoholism, surgical interventions and patients with altered consciousness).
Less often, the lung abscess is caused by a necrotizing pneumonia, which can develop following a suppurative thrombus embolism or an endocarditis of the right heart chambers; in contrast to inhalation, these conditions typically result in multiple abscesses rather than single ones.
The most commonly involved agents in abscesses are aerobic and anaerobic streptococci, but many other pathogens can support infection; these include: Staphylococcus aureus, Klebsiella pneumoniae and Haemophylus influenzae . The entry of these pathogens into the lungs initially generates inflammation, which leads to tissue necrosis and abscess formation. Generally, this lesion tends to break in a bronchus and its contents are expectorated, leaving a cavity full of air and liquid. In some cases, the direct or indirect extension (via bronchopleuric fistula) of the abscess to the pleural cavity results in an empyema.
The abscess is not always caused by an infection; non-infectious causes include bronchiectasis, pulmonary embolism and infarction, silicosis, neoplasms, sarcoidosis and Wegener's granulomatosis.
The lung abscess can develop in only one lung or in both and can reach sizes ranging from a few millimeters to 4-6 centimeters.
Most common symptoms and signs *
- Halitosis
- Anorexia
- Asthenia
- Chills
- Catarrh
- Dyspnoea
- Drumstick fingers
- Chest pain
- hemoptysis
- Hemoptysis
- Pleural empyema
- Temperature
- Pus formation
- Multiple pulmonary nodules
- Solitary pulmonary nodule
- Weight loss
- rales
- Cough
- Pleural effusion
- Nasal voice
Further indications
Lung abscess manifests itself with non-specific symptoms similar to those that develop in pneumonia. Usually, persistent cough, fever equal to or higher than 38 ° C, intense sweating and weight loss appear for weeks or months.
The cough can be productive, with expectoration of muco-purulent or hemoftoic material (mixed with blood), sometimes with a very intense putrefactive odor.
Lung abscess can also cause chest pain, dyspnoea (difficulty breathing) and general impairment.
Possible complications include pleural empyema (presence of pus in the pleural cavity), hemoptysis (emission from the mouth of blood from the airways) and chronic abscess. The reduction of respiratory noise indicates the presence of areas of parenchymal consolidation or pleural effusion.
The diagnosis is formulated on the basis of chest radiography or, if in doubt, with the CT scan.
Treatment generally involves the use of antibiotics by general route (intramuscular or intravenous injective use), selected on the basis of an antibiogram subsequent to blood culture or a culture test performed on the bronchial secretion.
In case of persistence of the abscess, it may be necessary to proceed with surgical therapy through drainage of the lesion percutaneously or through its removal by thoracotomy.
