Lung

Case report:

A 54 year old patient comes into practice and complains of night sweats, fever up to 39 � C for two weeks and plenty to half a cup of extensive purulent fetid expectoration. Furthermore, there are loss of appetite, diarrhea and sometimes pain in the rear upper back with a deep inhalation. The patient is known in practice for many years because of alcoholism; he indicates a Alkoholexze� with subsequent hypothermia about five weeks ago. Since that time, he was suffering from cough, which was handled in the past two weeks in a productive cough. The physical examination of the patient is underweight results in a body temperature of 38.5 � C, a respiratory rate of 20 / min, a weakening of the knocking sound dorsally over the central parts of the lungs with there also existing bronchial. Furthermore, there are typical findings as not decompensated cirrhosis.

Diagnosis:

The history and the clinical findings point raised in this patient indicate a abscess pneumonia of the right lung. A once-built chest radiograph confirmed that suspicion with a 5 cm in diameter amounting abscess in the sixth segment of the right lung. In blood, there is a leukocytosis of 28,000 / ul with marked left shift (12 bar polynuclear granulocytes); the CRP value is increased with 125 mg / l. The patient is stationary instructed to exclude post-stenotic pneumonia by bronchoscopy and to initiate parenteral therapy, at least in the initial phase.

Pathogenesis:

The overwhelming majority of lung abscesses arising from Aspirationsvorg�ngen. Here oropharyngeal secretions materials are aspirated with disturbed bronchioalveol�rer clearance, and in most cases the so-called Aspirationssegmente the right lung are affected the patient is lying down. About necrotizing pneumonia with inclusions of the lung parenchyma up to a diameter of 2 cm, it comes then to develop a Lungenabszesses. Rarely do such einschmelzenden inflammatory processes by septic metastases, for example, with right-sided and secondary poststenotic consecutive Bronchusverschlu� by tumor or foreign body. Each lung abscess should be bronchoscopy to secure the microbial etiology and to the exclusion of a morphological or functional stenosis. Etiologically there are mostly mixed infection of aerobic bacteria such as staphylococci, streptococci, Klebsiella pneumoniae and anaerobic streptococci and Bakteroidesarten.

Therapy:

The standard treatment for necrotizing pneumonia previously consisted of the combination of clindamycin (SOBELIN) with a parenteral cephalosporin [eg Cefotaxime (Claforan) or cefuroxime (CEFUROXIME et al)]. Meanwhile, there are also prospective randomized studies that showed an effectiveness of ampicillin plus sulbactam (UNACID). The treatment of this life-threatening disease should first be carried out parenterally in the clinic in order to ensure the effectiveness of therapy. After ten to 14 days treatment to oral antibiotics can be converted resistance requirements. Oral therapy should be continued until the disappearance of radiological Absze�befundes and to the normalization of inflammatory parameters. This may well be necessary for several months. With exclusion of endobronchial stenosis can be treated conservatively today each lung abscess successfully - a surgical procedure or the placement of so-called Sp�lkathetern is not necessary.