It is a lesion in the lung parenchyma, that contains purulent material. That may cause extreme dyspnea and hoarseness, Sometimes occurs after pneumonia, cough worse in cold air.
Etiology / Causation
Necrotizing infection
Tuberculosis
Pyogenic bacteria
Fungi
Parasites
Cavitary infarction(embolic)
Blood embolism
Septic embolism
Vasculitis
Cavitary malignancy
Bronchogenic carcinoma
Metastatic lung cancer
Miscellaneous
Silicosis
Pneumoconiosis
Aspiration of septic materials
Pus, blood, infected mucus during operations, infected chest wounds, infected cysts.
Symptoms
More common in males
Onset may be acute or insidious
Remittent pyrexia with shivering and sweating
Cough with purulent sputum, profuse and fetid.
Occasional hemoptysis
Chest pain
Constitutional symptoms like malaise, loss of appetite, body ache, etc.
Signs
The patient is toxic - Temperature high
Pulse tachycardia
Clubbing of fingers.
Examination of chest
Signs of consolidation. Restricted movements of the affected side. The trachea may be shifted to the opposite side. Dullness or stony dullness if there is effusion. Vocal fremitus increased. Breath sound bronchial, high-pitched. Fine crepitation in early stages, later on, replaced by coarse. Vocal resonance increased.
Investigation
Blood: Leukocytosis - 15,000 to 35,000 per cubic mm.
Bronchoscopy: To exclude foreign body or carcinoma.
X-ray: Homogeneous lobar or segment opacity with consolidation or collapse. In later stages, sign of air / fluid level in the cavity. If the cavity wall is thick, the possibility of underlying T.B and fungal infection is to be kept in mind.
Compare to empyema
In acute empyema, the chest will slow the features of pleural effusion. Bulging of intercostal spaces and local skin exfoliation is present. X-ray chest will be helpful, on aspiration, pus will be seen.
Complication
Atelectasis: lobar or lobular
Bronchiectasis
Bronchitis
Cystic degeneration of lungs
Spontaneous rib fracture
Pneumonia
Respiratory failure
Cor pulmonale
Embolism
Treatment
During a severe attack: Oxygen inhalation
Maintain fluid and electrolyte balance
Avoidance of offending substances e.g. smoke, fumes, etc.
Chest exercises.
Homeopathic medicine (Expert Homeopathy: Dr. Anutosh Chakraborty)
Calcarea Carb: Extreme dyspnea, and hoarseness, worse morning. Expectoration thick and profuse sweating indicate this medicine.
Hepar Sulph: Chilly patient with a tendency for suppuration. Cough worse when walking. Rattling cough, worse morning. Choking cough with fever.
Phosphorus: Abscess in the lung after pneumonia. Cough, worse cold air, sweetish taste while coughing.
Silicea: Cough with expectoration in the day, bloody or purulent. Violent cough when lying down, with thick, yellow lumpy expectoration.
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