Current aspects of diagnostics and surgical treatment of acute lung abscesses
Keywords:lung abscess, ultrasonic imaging, computed tomography, thoracoscopy, thoracic surgical procedure
Increasing number of lung diseases, unfavorable environmental factors, dissemination of infectious agents in a patient's body result in increased frequency of purulent-septic complications, thereby making the study on methods of their diagnosis and treatment relevant.
Aim of the work: to examine the diagnostic value of lung ultrasound (US) and spiral computed tomography (SCT) in the diagnosis of acute abscesses and in determining the tactics of surgical treatment.
Materials and methods. A prospective study of 40 cases of acute lung abscesses with diagnostic value of US and SCT examination to choose a surgical method in accordance with the type of acute lung abscess.
Results. Male was dominated in the study (82.5 %). The median age was 52 (43.5; 60.0) years. SCT revealed an abscess with sequestration in 9 (22.5 %) of 40 patients, which was confirmed during surgery. A false negative result was obtained in 5 (35.7 %) patients out of 14. Lung US revealed sequestration in 14 (35.0 %) patients: 2 (14.3 %) of them were false positive. Transthoracic drainage was performed in 24 (92.3 %) of 26 patients without sequestration. In 2 (7.7 %) cases – video abscessoscopy (VAS). The median length of hospital stay was 34.5 (29.0; 43.0) days for patients without sequestration and 32.0 (26.0; 35.0) – with sequestration, Р = 0.16.
Conclusions. Modern radiation imaging is an effective tool for the diagnosis of lung abscess. The sensitivity and specificity of computed tomography was 64.3 % and 100.0 %, sonography – 85.7 % and 92.3 %, respectively, in the study. The concurrent use of these diagnostic methods increases their information content: sensitivity up to 100.0 %, specificity up to 92.3 %. Video abscessoscopy with sequestrectomy is an effective method of treatment and etiological diagnosis of the process, which allows achieving the length of hospital stay comparable to patients without sequestration: 32.0 (26.0; 35.0) vs 34.5 (29.0; 43.0), Р = 0.16.
Zhang, J.-H., Yang, S.-M., How, C.-H., & Ciou, Y.-F. (2018). Surgical management of lung abscess: from open drainage to pulmonary resection. Journal of Visualized Surgery, 4, Article 224. https://doi.org/10.21037/jovs.2018.10.14
Loukeri, A., Kampolis, C., Tomos, P., Papapetrou, D., Pantazopoulos, I., Tzagkaraki, A., Veldekis, D., & Lolis, N. (2015). Diagnosis, treatment and prognosis of lung abscess. Pneumon, 28(1), 54-60. http://www.pneumon.org/Diagnosis-treatment-and-prognosis-of-lung-abscess,137140,0,2.html
Matarese, A., Tamburrini, M., Desai, U., & Zuccon, U. (2020). Percutaneous lung abscess drainage: revisiting the old gold standard. Monaldi Archives for Chest Disease, 90(1). https://doi.org/10.4081/monaldi.2020.1214
Teng, E., Bennett, L., Morelli, T., & Banerjee, A. (2018). An unusual presentation of pulmonary embolism leading to infarction, cavitation, abscess formation and bronchopleural fistulation. BMJ Case Reports, Article bcr-2017-222859. https://doi.org/10.1136/bcr-2017-222859
Yun, S. S., Cho, H. S., Heo, M., Jeong, J. H., Lee, H. R., Ju, S., Kim, J. Y., You, J. W., Cho, Y. J., Jeong, Y. Y., Kim, H. C., Lee, J. D., & Lee, S. J. (2019). Lung abscess by Actinomyces odontolyticus and Parvimonas micra co-infection presenting as acute respiratory failure. Medicine, 98(35), Article e16911. https://doi.org/10.1097/md.0000000000016911
Miki, M. (2019). Standard and Novel Additional (Optional) Therapy for Lung Abscess by Drainage Using Bronchoscopic Endobronchial Ultrasonography with a Guide Sheath (EBUS-GS). Internal Medicine, 58(1), 1-2. https://doi.org/10.2169/internalmedicine.0968-18
Shivachev, H., Pahnev, Y., Antonova, Z., Tolekova, N., Georgiev, T., Strahinova, V., Gabrovska, N., Velizarova, S., & Karamisheva, V. (2019). Complex minimally invasive approach for complicated parapneumonic pulmonary abscess with bronchopleural fistula in childhood. European Respiratory Journal, 54, Article PA2218. https://doi.org/10.1183/13993003.congress-2019.pa2218
Miniati, M., Bottai, M., Ciccotosto, C., Roberto, L., & Monti, S. (2015). Predictors of Pulmonary Infarction. Medicine, 94(41), Article e1488. https://doi.org/10.1097/md.0000000000001488
Konietzke, P., Mueller, J., Wuennemann, F., Wagner, W. L., Schenk, J. P., Alrajab, A., Kauczor, H. U., Stahl, M., Mall, M. A., Wielpütz, M. O., & Sommerburg, O. (2020). The value of chest magnetic resonance imaging compared to chest radiographs with and without additional lung ultrasound in children with complicated pneumonia. PLOS ONE, 15(3), Article e0230252. https://doi.org/10.1371/journal.pone.0230252
Williamson, J. P., Grainge, C., Parameswaran, A., & Twaddell, S. H. (2017). Thoracic Ultrasound: What Non-radiologists Need to Know. Current Pulmonology Reports, 6(1), 39-47. https://doi.org/10.1007/s13665-017-0164-1
Dietrich, C. F., Mathis, G., Cui, X. W., Ignee, A., Hocke, M., & Hirche, T. O. (2015). Ultrasound of the Pleurae and Lungs. Ultrasound in Medicine & Biology, 41(2), 351-365. https://doi.org/10.1016/j.ultrasmedbio.2014.10.002
Raheja, R., Brahmavar, M., Joshi, D., & Raman, D. (2019). Application of Lung Ultrasound in Critical Care Setting: A Review. Cureus, 11(7), Article e5233. https://doi.org/10.7759/cureus.5233
Yaguchi, D., Ichikawa, M., Inoue, N., Kobayashi, D., Shizu, M., & Imai, N. (2018). Transbronchial drainage using endobronchial ultrasonography with guide sheath for lung abscess: A case report. Medicine, 97(20), Article e10812. https://doi.org/10.1097/MD.0000000000010812
Izumi, H., Kodani, M., Matsumoto, S., Kawasaki, Y., Igishi, T., & Shimizu, E. (2017). A case of lung abscess successfully treated by transbronchial drainage using a guide sheath. Respirology Case Reports, 5(3), Article e00228. https://doi.org/10.1002/rcr2.228
Hayama, M., Izumo, T., Matsumoto, Y., Chavez, C., Tsuchida, T., & Sasada, S. (2015). Complications with Endobronchial Ultrasound with a Guide Sheath for the Diagnosis of Peripheral Pulmonary Lesions. Respiration, 90(2), 129-135. https://doi.org/10.1159/000431383
Takaki, M., Tsuyama, N., Ikeda, E., Sano, M., Matsui, K., Ito, H., Kakiuchi, S., Yamashita, Y., Tanaka, T., Ariyoshi, K., & Morimoto, K. (2019). The Transbronchial Drainage of a Lung Abscess Using Endobronchial Ultrasonography with a Modified Guide Sheath. Internal Medicine, 58(1), 97-100. https://doi.org/10.2169/internalmedicine.9419-17
How to Cite
LicenseAuthors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)