Infectious diseases

At the following infectious diseases of the thorax often a surgical therapy is required:
 
 

Pleural empyema

A pleural empyema is an accumulation of pus in the pleura, which means between the two pleural layers, pleura visceralis and pleura parietalis, or with other words between the lungs and the chest wall.

The most frequent type of the pleural empyema isparapneumonic empyema, that occurs at lung inflammation. Inflammatory liquid occurs which first is watery and then purulent. As antibiotics have no effect on bacteria in this liquid a drainage has to be performed. As another reason a cavern can break into the pleural cavity due to a lung abscess.

Symptoms for a pleural empyema are high fever, chest pain and possible respiratory distress. The diagnosis is based on the anamnesis, thoracic X-ray and computer tomography.

The diagnosis is assured by a sample puncture with bacteriologic examination.

Therapy
If the bacterial infection of the punctate is proven, the pleural cavity needs to be drained. At loculated empyema thoracoscopy or thoracotomy with complete removal of cavity content and targeted drainage is indicated.

 

Lung tuberculosis

Tuberculosis is a chronic infectious disease, which is spread globally and gains importance also in industrial states due to HIV and immigration. Worldwide yearly almost two million people die from tuberculosis. Poor nutrition, low social conditions and a weakened immune system encourage infections and diseases. Tubercle bacteria (mycobacteria tuberculosis) are pathogens, which are transmitted by droplet infections. In our region tuberculosis is rare and we often find a past infection as inflammatory tumor-like growths, so-called granuloma. We also sometimes detect active infections in destroyed lung areas.

Therapy
The therapy is mainly medicinal with a specific long-lasting antibiotics combination. A surgical intervention is nowadays only indicated in complicated developments, for example in persistent caverns, caverns with superinfections, lung bleeding (hemoptysis), bronchial stenosis, tuberculoma (> 2cm) and multiresistent pathogens. Granulomas are extracted to find the cause for the "tumor" found by intention.

 

Bronchiectasis

Pathological enlargement of bronchial system parts is defined as bronchiectasis, in which increased bronchial mucus is accumulating, that can't be coughed up or only very hard. Thus an increased infection risk arises, which might lead to severe complications. Bronchiectasis can be congenital or might also occur after severe inflammatory processes, which lead to a destruction of the bronchial walls. The illness is characterized by massive coughing and enormous production of thick, purulent secretion.

With heavily impairing symptoms and returning infections a partial resection of the affected lung area might be performed. In case of clear symptoms, such as improved sputum production or hemoptysis, a CT thorax proves the diagnosis of bronchiectasis.

Therapy
In case of recurring infections despite adequate antibiotic therapy and life-threatening lung bleedings the indication for segment resection or lobectomy is given. This can be performed minimally invasive and leads to a significant improvement of symptoms.

 

Aspergillosis

Aspergillosis (aspergillus flavus) is a globally spread disease. It is a fungal infection that can also affect the lungs. Chronic abscess cavities can often get superinfected with aspergillus, what leads to the development of an aspergilloma.

The most frequent symptom of an aspergillosis is a hemoptysis, which might develop to a life-threatening bleeding. In the computer tomography of the thorax often so-called fungus balls are found in cavern-like destroyed areas of the lung parenchyma.

Aspergillus OL-rechts.jpg
 Aspergillus in the right upper lobe

Therapy
The affected lung parts should be resected in complicated cases.

 

Lung abscess

In the lung an abscess fistula can form, which is called a lung abscess, which in rare cases needs to be emptied in the course of a surgery or by means of a puncture. Cause of such abscesses are often bacteria or parasites. The germs, that make their way by aspiration into the deeper respiratory passages, are typically so-called anaerobes (bacteria, which are not or only weakly growing in the presence of oxygen). Anaerobes are often found in the mouth and throat region, in furrowed tissue of the Tonsils and the gum folds. Anaerobes such as peptostreptococcus, prevotella, bacteroides and fusobacterium appear most frequently in lung abscesses.

A lung abscess is rarely developed due to bacteria, which came not by aspiration into the lung. These bacteria (no anaerobes) can often also cause lung inflammations without abscess formation. Among them are staphylococcus, streptococcus, klebsiella, hemophilus, legionella or pseudomonas.
If the patient has a weak immune system, often only rarely occurring germs such as nokardia, actino-mycetes, atypical mycobacteria, fungi (aspergillus, cryptcoccus neoformans, histoplasma capsulatum) or parasites (unicellular micro-organisms, e.g. amebas, worms or in tropical regions occurring lung fluke) can be found.

Therapy
Generally the therapy is performed conservatively. Only rarely a surgery is necessary. Indications for a segmentectomy or lobectomy are failure of conservative treatment, caverns with a risk of recurrence, aspergilloma, life-threatening lung bleedings, bronchopleural fistulas.


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