Lung gangrene is a progressive putrefactive decay of the lung parenchyma under the influence of anaerobic infection. Predisposing diseases may be chronic alcoholism, diabetes mellitus, aspiration from foci of purulent infection in the mouth and pharynx, pneumonia in weakened patients.
A distinction is made between acute gangrene within the anatomical boundaries of a lobe (lobes) without a delimiting pyogenic membrane and a gangrenous, often giant, abscess.
Symptoms and course
The course is acute. There is a rapid, generalized breakdown of lung tissue with putrid, bloody sputum containing elastic fibers, fatty acids, crystals of leucine and tyrosine.
The resulting purulent-resorptive fever is quickly replaced by purulent-resorptive exhaustion, consciousness is confused, and the body temperature becomes subfebrile. When the white blood count shifts to the left, there is only slight hyperleukocytosis, hypoproteinemia and dysproteinemia are pronounced.
Breathing is usually weakened, less often amphoric over the decay cavity. X-ray reveals a limited darkening, often with a horizontal level of fluid in the pleural cavity and/or in the abscess cavity. Using tomography, the boundaries of the breakdown of lung tissue are clarified.
Treatment
Depending on the phase of development, treatment can be conservative or surgical.
When using cephalosporins, intensive infusion therapy, repeated courses of plasmapheresis, intravenous administration of fresh frozen plasma in the amount of 200 ml per day (administered in a stream or rapid drops), metronidazole in the early phase, success can be achieved in 65% of patients.
Surgical treatment is indicated for profuse pulmonary arrosive bleeding and in all cases of development of pleurisy, with improvement of the volemic background.
Forecast
The prognosis for lung gangrene is unfavorable.