I- Overview :
It s & rsquo; d & rsquo acts; parenchymal necrosis l & rsquo; microbial attack of the lung parenchyma by pyogenic germs that will result in the formation of pus. Depending on the location of the pus are identified 2 groups :
At the & rsquo; cell : primitive lung abscess pus = At d & rsquo; a preexisting cavity : secondary suppuration
II- DEFINITION :
L & rsquo; lung abscess is an acute suppurative, collected in a cavity néoformée, cut into the previously healthy lung parenchyma and caused by non-tuberculous infection (not specific).
III- CLINICAL STUDY :
L & rsquo; abscess evolves 3 stages
A- STAGE HOME FARM :
The onset is sudden
* Functional and general signs are marked by :
A fixed side point
A fever 38 – 39°c, chills, accelerated heartbeat, a general weakness with anorexia (TIME) ->Dry cough PFLA, annoying, painful.
* L & rsquo; physical examination : discreet, according & rsquo; scope
submatités translating localized pulmonary condensation homes (alveolitis fibrin-leukocyte) The crackles, rarely breath tubal
* Radiology shows : A dense opacity, homogeneous, systemized evil and fuzzy boundaries (alveolar pneumonia)
B- STAGE nux :
Corresponds to rejection, in a violent effort to cough, d & rsquo; a large quantity of pus. It can be solid or split in the day. Overlooking tearing sensation.
The signs or prodromal symptoms are :
Tearing d & rsquo; syncope appearance felt in the chest +++
C- STAGE OPEN HEARTH :
Regroup 2 syndromes
1- The general suppurating syndrome : makes oscillating fever.
2- The pulmonary suppuration syndrome :
Made of heavy purulent sputum.
* physical signs :
Breath Cavity becomes clear
sounding moist rales condensed area
* Radio shows :
– air-fluid picture : typical
C & rsquo; is a rounded picture, thick limits, regular
A base : fluid opacity surmounted & rsquo; a clarity aeric, limited by a horizontal line regardless of the patient's position
* dgc differential :
Hydatid cyst ruptured, floating mb (undulating line)
Primary bronchial squamous Kc (limit within anfractueuse)
– single or multiple fuzzy opacity, blurry, variable & rsquo; a snapshot to another, but fixed d & rsquo seat; where interest d & rsquo; a TDM
* TDM : Specifies the number, headquarters, Nature excavated or not lesions and the presence of Fluid levels.
IV- DIAGNOSTIC PARACLINIQUE :
L & rsquo; bacteriological examination pus : critical time, allows & rsquo; study the bacterial flora, determine the dominant germ and practice susceptibility testing. However, BK must be negative.
The broncho-fibroscopie : Locates suppuration, d & rsquo; there practicing samples and check the permeability of bronchial explored.
FNS : leukocytosis accelerated VS and fibrinemieî.
Blood Sugar : Diabetes surtt if staph
Blood cultures which will be repeated if possible every feverish peak.
V- CLINICAL FORMS :
A- Bacteriological forms: more harmful :
1- anaerobes to abscess : Occurs in alcoholics performing abscess distance- "putrid gangrenous forms
2- Abscesses in Klebsiella pneumoniae or Bacillus Fried lambert : germ necrosis gives hémoptoïques sputum realizing extensive necroses. Its evolution is severe and leaves important legacy-type multiple cavities → aspergillosis graft
3- Staphylococcus abscess :
In infants : it gives digestive signs type abdominal bloating.
A la Rx : multiple opacities that blow giving lights affecting the pleura -> pyopneumothorax.
In adults, it gives multiple abscesses + nodular infiltrating septicopyohémique especially in diabetics.
4- Abscess other germs : A pneumococcal, to Streptococcus, in Hemophilus influenzae and BGN.
5- parasitic abscess : especially amoebic. We must look for a history of living in area & rsquo; endemic or a home amoebic suppurating.
B- The etiological forms :
* Broncho-pulmonary infections :
DDB + BC - "chronic
bacterial and viral pneumonia - "acute
* Suppuration Neighborhood :
empyema, suppurative mediastinitis (Kc of & rsquo; esophagus), suppuration under phrenic (liver abscess, peritonitis)
* infectious focus distance :
ORL, dental, surgical intervention (appendicitis, cholecystitis)
* particular context : penetrating wound of the peritoneum (trauma), accident swallowing due to a coma or anesthesia
WE- ÉVOLUTIOIN :
* It is generally favorable :
Fall and resolution of fever and coughing after 8 days
radiological signs that normalize to about the 3th week (it s & rsquo; improves 10-15J).
* adverse developments : residual cavity which is the seat of & rsquo; chronic abscess. It is a provider of DDB.
Complications locales :
clear or empyema.
Aspergillome intra cavitaire
General complications :
infectious arthritis cachexia →
Remote abscess including the & rsquo; brain abscess.
Septicemia secondary amyloidosis
VII- TREATMENT :
A- Medical treatment : Depends on the isolated germ and ground
1- appropriate antibiotic therapy : give by susceptibility testing method or proportion (antibiogramme), synergistic
The duration of treatment is 4-6 week, the most of 8 weeks.
2- The door & rsquo; entry : ORL, dental
3- Terrain : eg balance diabetes
4- Physiotherapy : depends on & rsquo; etiology
B- surgical treatment : It is rarely mentioned. When & rsquo; s it & rsquo; is, must be pre careful balance Indication : DDB localized poorly tolerated, chronic abscess, superinfected abscess sequelae (Kc), obstruction.
C- Surveillance : mandatory, must be long continued to d & rsquo; prevent recurrences that are possible tjrs Time : > 6-8weeks =>Rx as possible, recurrence
Courses of Dr. Madache – Faculty of Constantine