Differential diagnosis with Lung Carcinoma

The tactics in acute pulmonary destruction

•mainly conservative

•The adequate antibacterial, antiinflammatory therapy consists of intravenous introduction of antibiotics of a wide spectrum activity

•Injection of antibiotics in the vessels of a pulmonary circulation by means of catheterization of central veins, pulmonary artery;

•into respiratory tracts (in the second stage) – through the endotracheal microirrigator, nasogastric tube, during bronchoscopies, endoscopic catheterization of the abscess cavity through the draining bronchus, in aerosolic inhalations.

Tactics:

•Evacuation of purulent content of the cavities

•Homeostatic correction (oxygenotherapy, correction of anemia, hypoproteinemia, acidosis, microcirculatory disturbance)

•Correction of dysfunction of the vital organs and systems, prevention of complications, symptomatic therapy.

Surgery, indications

•Pulmonary bleeding of ІІ- ІІІ degree;

•- Progression of the process on the background of active and appropriate therapy;

•- Tense pyopneumothorax, which is failed to liquidate by the draining of pleural space;

•- Impossibility to rule out the suspicion on a malignant tumour.

Operations

•Operational incisions – anterolateral, lateral and posterolateral thoracotomy.

•The operation suggests segmental, polysegmental resection, lobectomy, bilobectomy combined intervention (with the decortication, pleurectomy).

Lateral thoracotomy

Posterolateral thoracotomy

Anterior thoracotomy

Pleural empyema

•The pleural empyema is a purulent inflammation of its visceral and parietal membranes, which is associated with accumulation of pus in a pleural space.

Etiology and pathogenesis

•inflammatory, or purulent and destructive processes of lungs,

•abscesses of abdominal cavity (secondary pleural empyema),

•open and closed damages of chest,

•in some cases, operative approaches on thoracic organs (primary pleural empyema).