Definition of abscess chest: Pus accumulation in pleural cavity due to bacterial infection
Acute abscess thorax
Etiology: Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus, and rarely E. coli, Bacillus pneumoniae
Route of infection.
Secondary intrapulmonary infection: inflammation and suppuration of the lung, invasion and rupture into the thoracic cavity
Thoracic trauma: pathogenic bacteria directly into the thoracic cavity, hemothorax causing infection
Post-thoracic complications: anastomotic fistula Blood-borne infections: sepsis, septicemia
Spread of septic lesions in adjacent organs: liver abscess, subdiaphragmatic abscess, mediastinal abscess, septic pericarditis, etc.
Pathogenesis.
Bacterial infection occurs with congestion and edema and exudation – Exudate contains leukocytes and fibrin – Inflammation develops and gradually forms pus – Fibrin settles on the pleural surface and forms a fibrous Membrane – Mechanized toughness increases to form fibrous plates
Clinical manifestations.
Symptoms: acute inflammation, dyspnea, high fever, chest pain, shortness of breath, cough, coughing up thick sputum, even cyanosis and infectious shock Signs: acutely ill face, reduced respiratory movements, fullness of the intercostal space, solid sounds on percussion, diminished or absent breath sounds, tracheal and cardiac turbid borders favoring the healthy side
Examination.
Blood analysis: increased leukocyte and neutrophil count
Sputum culture: positive
Pleural effusion culture: positive
Imaging: dense shadow of the affected side of the chest, mediastinum may be biased to the healthy side, lung compression
Treatment principles.
Control infection, eliminate pus as much as possible, eliminate residual cavity, promote early lung reopening and systemic support.
Most children with abscess thorax can be cured after conservative medical treatment, treatment measures: infection control: adequate and effective antibiotics, combination of drugs thoracentesis: early, thin pus, according to chest X-ray and ultrasound positioning. Closed thoracic drainage: pus is not easy to be extracted by puncture, lung rupture with pneumothorax, bronchopleural fistula’s, full abscess chest with more pus systemic treatment: high fever, high protein, high vitamin diet, electrolyte supplementation, nutritional support, blood transfusion if necessary, getting out of bed, coughing and sputum.
Chronic abscess chest
Definition: acute abscess chest disease more than 6 weeks, pus cavity wall hardening, fiber plate formation, pus cavity volume fixed.
Etiology: poor drainage and retention of pus due to improper early treatment of acute abscess chest.
Pathogenesis: long-term accumulation of pus in the chest cavity, thickening of the fibrous membrane and mechanization of the bound lung, lung compression and dystocia – contraction of the fibrous scar of the pleura, narrowing of the rib space, restriction of respiratory movement – long-term infection, systemic consumption
Clinical manifestations.
Symptoms:chronic toxic symptoms, hypothermia, malaise, wasting, anemia, hypoproteinemia Signs:collapse of the affected thorax, narrowing of the rib space, reduced respiratory motion, pestle finger, diminished and absent breath sounds, solid percussion sounds.
Examination:hypoprotein, anemia, rapid hematocrit, positive pus culture, pulmonary function suggesting restrictive contemporaneous dysfunction.
Imaging:Pleural thickening, rib space narrowing combined with bronchopleural fistula patients, intrathoracic injection of methylene blue, can be coughed out from the sputum.
Treatment principle: eliminate the cause of abscess chest, eliminate abscess chest, and strive to preserve and restore lung function. Improve the patient’s general condition and resistance.
Surgical modalities.
Thoracoplasty: remove the corresponding part of ribs and thickened fiber plate of the abscess cavity on the affected side, preserve the periosteum of ribs and intercostal muscles, eliminate the granulation tissue on the dirty layer of fiber plate, and collapse the chest wall to eliminate the abscess cavity.
Pleuropneumonectomy: Chronic abscess chest with extensive lesions in the lung. Combined with lung abscess, destroyed lung, severe pulmonary tuberculosis, branched expansion.