Acute lung abscess

　　Lung abscess refers to necrotic changes in the lung parenchyma caused by microorganisms, forming a cavity containing necrotic matter or liquefied necrotic matter. The causes of different types of acute lung abscesses are different. The following is a specific introduction:

　　1. Inhaled lung abscess

　　Pathogens are inhaled through the mouth, nose, and oropharynx, which is the most important cause of acute lung abscess. Purulent secretions such as tonsillitis, sinusitis, and dental abscesses; blood clots after oral, nasal, and oropharyngeal surgery; dental plaque or vomit, etc., under conditions such as unconsciousness, general anesthesia, etc., are aspirated into the lung through the trachea, causing obstruction of the bronchioles, and the pathogens can then multiply and cause disease.

　　2. Hematogenous lung abscess

　　Sepsis and septicemia caused by skin trauma, boils, osteomyelitis, subacute bacterial endocarditis, etc., can lead to sepsis and septicemia. Pathogens (most often Staphylococcus aureus), septic emboli, are transported to the lung via the minor circulation, causing thrombosis of small blood vessels, inflammation and necrosis of lung tissue, and the formation of abscesses.

　　3. Secondary lung abscess

　　This type of lung abscess often develops secondary to other diseases, such as secondary infections caused by Staphylococcus aureus and Klebsiella pneumoniae pneumonia, cavitary pulmonary tuberculosis, bronchiectasis, and bronchogenic carcinoma, etc., which can cause acute lung abscess. Suppurative lesions or trauma infections of adjacent organs of the lung, subdiaphragmatic abscess, perinephric abscess, paravertebral abscess, esophageal perforation, etc., penetrating into the lung can also form abscesses.

　　4. Amoebic lung abscess

　　Amoebic lung abscess often develops secondary to amoebic liver abscess. Since liver abscesses commonly occur at the top of the right lobe of the liver, they are prone to penetrate the diaphragm and reach the lower lobe of the right lung, forming an amoebic lung abscess.

　　What complications can acute lung abscess easily lead to

　　Acute lung abscess refers to lung abscess with an onset time less than 6 weeks. Generally, this disease has the following common symptoms:

　　1. Sudden chills, high fever, accompanied by general weakness, profuse sweating, poor appetite, weight loss, and other symptoms.

　　2. Cough, chest pain, and expectoration of a large amount of sputum with a foul smell from the 5th to the 15th day of onset.

　　3. Formation of tension cavities, with thin walls, which can compress surrounding lung tissue or the mediastinum.

　　4. It may be accompanied by a small amount of pleural effusion, empyema, or pyopneumothorax.

　　Pulmonary abscess is an infectious inflammation of the lung parenchyma caused by mixed infection of various pyogenic bacteria. The aspiration of secretions from the oral, nasal, and pharyngeal cavities containing pathogenic bacteria is the main cause of the disease. Therefore, the key to preventing this disease is to actively remove and treat chronic infection sources in the oral, nasal, and pharyngeal cavities, such as dental caries, tonsillitis, sinusitis, and alveolar abscess. Avoid excessive use of sedatives, hypnotics, anesthetics, and alcoholism. For those who have undergone upper respiratory surgery and are in a state of coma or under general anesthesia, intensive care should be provided to prevent pulmonary infection. Treatment should start with strong antibiotics early, and sputum drainage is also an important measure to improve efficacy. This disease can be cured with active and effective treatment. For chronic pulmonary abscesses, especially those with thick-walled cavities or repeated massive hemoptysis after 3 months of antibiotic treatment, surgical resection can be considered.

　　Based on the medical history such as oral surgery, coma with vomiting, foreign body aspiration, acute onset, aversion to cold, high fever, cough, and expectoration of large amounts of smelly sputum, combined with the following examinations, the disease can be diagnosed.

　　1. Chest X-ray and chest CT scans

　　Inhalation cases are more common in the posterior segment or apical-posterior segment of the upper lobe, the dorsal segment and basal segment of the lower lobe, with the right side more than the left. In the early stage, there are large areas of dense shadows with unclear edges, often with fluid-filled cavities with smooth inner walls and inflammatory infiltration around. Blood-borne cases may show multifocal areas of increased density on the periphery of one or both lungs, or round or elliptical dense shadows, which may form cavities. Sometimes, empyema or pyopneumothorax may occur concurrently.

　　2. Laboratory tests

　　There is a significant increase in blood leukocyte count and neutrophils, and in patients with a longer course of the disease, there may be a decrease in total red blood cell count and hemoglobin.

　　3. Sputum examination

　　When there is a combined infection of anaerobic bacteria or anaerobic bacteria, the sputum has an odor, and it can be divided into three layers after standing still. When dealing with lung abscess, sputum smears for Gram staining and bacterial culture, as well as drug sensitivity tests should be performed. Anaerobic bacterial cultures should be done when possible. It is necessary to find acid-fast bacilli, parasite eggs, and tumor cells when necessary. For blood-borne cases, sputum smears and cultures of extrapulmonary local abscesses or inflammatory foci can be performed. For those with concurrent empyema, thoracentesis to aspirate fluid for examination can be done.

　　4. Fiberoptic bronchoscopy examination

　　Fiberoptic bronchoscopy can understand the cause and location of obstruction; protective brush for cell and acid-fast bacillus examination; sputum for bacterial smear and culture; tissue for pathological examination; lung tissue biopsy (TBLB) can be performed through fiberoptic bronchoscopy. If necessary, lung lavage can be performed through fiberoptic bronchoscopy for pathogenic and immunological examination.

　　Patients with this disease should pay attention to choosing light and easy-to-digest foods in their diet, and it is recommended to eat more fresh vegetables and fruits appropriately, especially to eat more foods such as white-berry, lily, white radish, lotus root slices, etc. At the same time, pay attention to avoiding spicy and irritating foods, avoiding smoking and drinking, and avoiding strong tea. Reduce staying up late, pay attention to rest, avoid too much emotional fluctuations, and when the condition is controlled, moderate exercise is recommended.

　　Acute lung abscess is often a mixed infection, including Gram-positive and Gram-negative cocci and bacilli that are aerobic and anaerobic. The treatment methods are as follows:

　　1. Anti-infection treatment

　　The treatment of acute lung abscess should, in principle, select antibiotics according to the results of bacteriology and drug sensitivity tests. Penicillin and amikacin can be used first, and the medication can be adjusted after the bacteriology and drug sensitivity reports. For those with anaerobic bacterial infections, the dose of penicillin G can be increased or lincomycin and metronidazole can be taken orally. For severe cases, intravenous infusion of cefoxitin can be considered. Local treatment can be performed on the basis of systemic medication, such as instillation of medication into the trachea through a nasal catheter or bronchoscope. Amoebic lung abscess should be treated with metronidazole and other antiamoebic drugs.

　　2. Postural expectoration and drug expectoration

　　Postural drainage should be adopted according to the location of the abscess and the condition, and expectorant drugs should be taken orally, such as Beishouping, Muxu痰, etc., and ultrasonic atomization can be performed if necessary.

　　3. Bronchoscope lavage

　　For those with a large amount of sputum or obvious signs of sputum obstruction, bronchoscope lavage and aspiration can be performed. Strengthen supportive treatment, and blood transfusion can be performed in small quantities and multiple times if necessary.

　　4. Surgical treatment

　　Surgical treatment can be considered for those with sputum containing pus for more than 3 months after routine medical treatment, or those with life-threatening massive hemoptysis or cannot be distinguished from lung cancer.