Pediatric Lung Abscess
Introduction
Introduction to Pediatric Lung Abscess Abscessoflung refers to the inflammatory lesions of the lung parenchyma caused by various bacterial infections, necrosis and liquefaction, forming a cavity containing pus, mainly secondary to pneumonia, followed by sepsis. Occasionally from adjacent tissue purulent lesions, such as liver abscess, underarm abscess or empyema spread to the lungs, in addition, tumor or foreign body compression can cause bronchial obstruction and secondary purulent infection, paragonimiasis, mites and amoeba can also Causes lung abscess. Primary or secondary immunodeficiency and the use of immunosuppressive drugs can promote its occurrence. basic knowledge The proportion of illness: the incidence rate is 0.01% - 0.03% Susceptible people: children Mode of infection: non-infectious Complications: empyema
Cause
Causes of pulmonary abscess in children
(1) Causes of the disease
The cause of the disease is Staphylococcus aureus, anaerobic bacteria are the most common, followed by Streptococcus pneumoniae, Haemophilus influenzae, hemolytic streptococcus, Klebsiella, Escherichia coli, Pseudomonas aeruginosa, etc. The latter is often mixed with anaerobic bacteria.
(two) pathogenesis
Pulmonary abscess is secondary to pneumonia, followed by sepsis. A few cases can be caused by adjacent tissue purulent lesions, such as liver abscess, subgingival abscess or empyema spreading to the lungs, airway foreign body secondary infection, bacterial contamination secretion, vomiting In some cases, it is inhaled into the lower respiratory tract, as well as paragonimiasis, aphid and lung pleural amoeba. Inhaled lung abscess is more common in older children, blood-borne lung abscess, secondary lung abscess is more common in infants and young children. .
Prevention
Pediatric lung abscess prevention
Acute pneumonia and sepsis should be treated promptly and thoroughly. When foreign matter in the respiratory tract is inhaled, foreign matter must be removed quickly. During the process of tonsillectomy and other oral operations, tissue should be avoided.
Complication
Pediatric lung abscess complications Complications
Empyema and bronchial pleural palsy.
Symptom
Pediatric lung abscess symptoms Common symptoms High fever chills Chest pain abscess empyema purulent dyspnea Abdominal pain fatigue night sweats
Onset is more urgent, fever is not stereotyped, there is persistent or relaxation type of high fever, can be accompanied by chills, cough can be paroxysmal, sometimes respiratory increase or wheezing, chest pain or abdominal pain, common night sweats, fatigue, weight loss, infants Children with vomiting and diarrhea, such as abscess and respiratory tract, cough out odor purulent, it is related to anaerobic infection, can hemoptysis, and even large hemoptysis, such as abscess ulceration, and the chest cavity, it becomes a empyema Bronchopleural palsy, symptoms can be relieved with the discharge of a large number of sputum, generally the thoracic movement of the affected side is weakened, the percussion is voiced, the breath sound is reduced, such as the abscess cavity, and the bronchial communication, local percussion can be empty voice, and Smell the tubular breath sounds or dry and wet voices, the voice conduction is enhanced, severe cases have difficulty breathing and cyanosis, and the chronic fingers can be seen in the clubbing (toe).
Examine
Examination of lung abscess in children
1. Acute phase: the total number of white blood cells is as high as (20 ~ 30) × 109 / L or higher, neutrophils increase, the left side of the nucleus; chronic white blood cells are close to normal, showing anemia.
2. Pathogen examination: pathogens can be obtained by purulent or tracheal aspiration secretion culture, smear smear staining, sputum common culture can find pathogenic bacteria, because this disease is mostly mixed infection of anaerobic bacteria, so If you suspect this disease, you should do anaerobic culture at the same time.
3. Sputum microscopy: purulent sputum can be as many as hundreds of milliliters, see elastic fibers during microscopy, which proves that the lung tissue is damaged.
Auxiliary inspection
1. X-ray examination: In the early stage, only the inflammatory infiltrates can be seen. The abscess formation shows a dense shadow of the lamellae. For example, the liquid level is visible in the bronchus, the surrounding ring is inflammatory infiltrated, and the wall of the chronic lung abscess becomes thick. Surrounded by increased density of fiber cords, with bronchiectasis, pleural thickening, blood-borne lung abscess in the two lungs can be seen in multiple lamellae thick shadows.
2. B-ultrasound and CT examination: can help identify lung abscess and empyema.
Diagnosis
Diagnosis and diagnosis of pulmonary abscess in children
diagnosis
In addition to medical history, symptoms and laboratory examination data, the X-ray posterior anterior and lateral chest radiographs can be used to determine the number, size and location of abscesses. The margins of the cavities are thick, and the surrounding lung tissue has inflammatory infiltration. The size of the abscess is relatively stable and does not change much in a short time.
Differential diagnosis
1. Bullous bullae: Pulmonary bullae after combined with Glucosamine pneumoniae or viral pneumonia should be differentiated from this disease. The lung bullae on the X-ray chest is thin, forming rapidly and disappearing naturally in a short time.
2. Secondary infection of bronchiectasis: According to the history of severe pneumonia or tuberculosis, a typical cough after a morning, combined with X-ray and bronchography, can be identified.
3. Tuberculosis: Lung abscess can be mixed with tuberculoma, hollow tuberculosis and caseous pneumonia. It should be tested for tuberculin, sputum smear or culture to find tuberculosis. On X-ray films, there is infiltration shadow around the tuberculosis cavity. Generally no liquid level, often with ipsilateral or contralateral tuberculosis spread lesions.
4. Congenital pulmonary cyst: the surrounding lung tissue is not infiltrated, the liquid cyst has a clear circular or elliptical shadow, and the whole balloon is swollen with a round or oval thin-wall translucent cyst.
