How does an abscess form?
Most often, the trigger is aspiration, that is, the entry of the contents of the mouth or stomach into the bronchi during deep sleep, intoxication, anesthesia, a convulsive attack, or when swallowing is impaired after a stroke. Microbes living in the oral cavity, especially when the teeth and gums are in poor condition, enter the lower parts of the lung. Inflammation develops, the tissue area becomes dead and melts, and a capsule forms around it. When the cavity communicates with the bronchus, pus begins to cough out, and a characteristic level of fluid appears on the image.
- Aspiration of mouth and stomach contents
- Complication of severe pneumonia
- Blockage of a bronchial tube by a tumor or foreign body
- Infection through the bloodstream
- Suppuration of a cyst or pulmonary infarction
- Typical localization - posterior sections and lower lobes
Causes and risk factors
The main factor is anything that interferes with airway protection and swallowing. These are alcohol abuse, severe neurological diseases, stroke, epilepsy, impaired consciousness, anesthesia and artificial ventilation. The condition of the teeth plays a significant role: carious teeth and periodontitis serve as a source of microbes. The likelihood is higher in people with diabetes, cancer, taking immunosuppressive drugs, as well as in those who have suffered severe pneumonia or have bronchial obstruction.
- Alcohol abuse
- Swallowing problems after stroke
- Epilepsy and disorders of consciousness
- Caries, periodontitis, poor oral hygiene
- Diabetes mellitus and immunodeficiency
- Tumor or foreign body in the bronchus
- Severe pneumonia with tissue destruction
Symptoms
In the first period, signs of severe inflammation predominate: high temperature with chills, sweating, weakness, chest pain when breathing, dry or unproductive cough, shortness of breath. There is little sputum, antibiotics in normal doses do not help much. The turning point occurs when the abscess breaks through into the bronchus: a coughing attack appears with the discharge of a large amount of purulent sputum with an unpleasant odor, the temperature drops, and health improves. If the drainage of pus is incomplete, the fever returns.
- High temperature with chills
- Chest pain when breathing and coughing
- Shortness of breath and weakness
- Copious purulent sputum with odor
- Hemoptysis
- Loss of appetite and weight loss
- Thickening of the terminal phalanges of the fingers during prolonged flow
Diagnostics
X-ray of the chest in two projections usually reveals a rounded darkening, and after a breakthrough, a cavity with a horizontal level of fluid. Computed tomography more accurately determines the size, number and location of cavities, the condition of the pleura and helps to distinguish an abscess from a disintegrating tumor and tuberculosis. Blood tests show signs of inflammation. Sputum examination is required, including culture and tuberculosis testing. Bronchoscopy is performed if a bronchial obstruction is suspected, as well as to sanitize the cavity.
- Chest X-ray in two projections
- CT scan of the chest
- Complete blood count, C-reactive protein
- Sputum culture with sensitivity testing
- Sputum examination for Mycobacterium tuberculosis
- Bronchoscopy according to indications
- Ultrasound of the pleural cavity for suspected effusion
Treatment and prevention
Treatment is carried out in a hospital. The basis is long-term antibacterial therapy, which is selected by the doctor taking into account the likely pathogens; the course usually lasts several weeks and does not stop at the first improvement. It is important to ensure the outflow of pus: postural drainage, breathing exercises, sanitation bronchoscopy, and for large cavities, drainage through the chest wall is used. Surgical removal of a section of the lung is rarely required if treatment is ineffective, there is massive bleeding, or there is a suspected tumor. Prevention includes dental treatment and correction of swallowing disorders.
- Hospitalization and long-term antibiotic therapy
- Postural drainage and breathing exercises
- Sanitation bronchoscopy
- Percutaneous drainage of large cavities
- Complete nutrition and protein replenishment
- Oral sanitation and dental treatment
- Lung resection if treatment fails
