GRENE.
Pulmonary Abscess.
Although abscess of the lung is almost always associated with pulmonary tuber culosis, it may also be the result of other local or neighboring pathological proc esses and injuries. Hence its considera tion here.
Mechanical injuries, such as fractured ribs and penetrating wounds, may cause abscess of the lung, especially in cases in which the vitality is below normal. This variety, however, will be considered un der THORAX ORGANS, INJURIES OF.
Symptoms.—When, in the course of pymmia or any other infectious disease in which the lungs are not primarily in volved, localized distress in one or both lungs, shortness of breath, etc., and a rise in temperature appear, abscess of the lung is a possibility. It can only be veri fied, however, by the presence of pus in the sputa. These are usually yellowish green and emit an offensive odor, though less so than in gangrene. At times they assume a reddish or brownish tinge and contain shreds of tissue which, micro scopically examined, often prove to be elastic fibres. Blood-corpuscles, alveolar epithelium, crystals of margarin, choles terin mold-fungi, and various bacteria, according to the causative malady, may also be found in the secretions.
In abscess occurring as complication of acute pneumonia there is an intermittent rise in the temperature, usually about the time of the crisis; and marked prostra tion appears. At first physical exam ination affords but little information, though the signs of consolidation persist. When an abscess of large size opens into the bronchi, however, the signs of a cav ity as witnessed in tuberculosis present themselves. The history of the case and the presence of the cavity afford oppor tunity for a certain diagnosis.
Simple abscess of the lungs is liable to be met with in one of four forms: The first is that in which the symptoms are very obscure from the beginning, and remain so until there suddenly oc curs a discharge of purulent matter. In the second form the symptoms resemble those of pleurisy with effusion, and in the third those of pulmonary tubercu losis. The fourth is that associated with
the variety of pneumonia which advances slowly from one lobule to another, or is characterized by a tendency to skip from one lung to the other. S. Seabury Jones (Med. News, Mar. 2, 'S9).
Local tenderness is an important sign of abscess of the lung. C. F. Withington ( Boston Med. and Surg. Jour., Mar. 10, '98).
Etiology. — Acute pneumonia is the disease in the course of which pulmonary abscess most frequently occurs next to pulmonary tuberculosis, but, at best, even here it is not a frequent complication. Septicmmia or pymmia may also be ac companied by abscess of the lung through infectious emboli. It is especially liable to occur in persons in whom the general health had been poor before the onset of the causative affection, and in lymphatic or alcoholic subjects.
In some forms of bronchopneumonia it is said to be frequently observed. It occasionally presents itself as a complica tion of abscesses in neighboring struct ures, the liver particularly, the pleural cavity, and of tumors and cysts.
Pathology. — The local lesions are merely those of an ordinary abscess, con taining micro-organisms, these varying, as stated, with the nature of the causa tive disease. Streptococci and the diplo coccus pneumonia; among others have been observed. The size of the abscess may vary greatly from that of a chestnut to that of a large orange. An abscess of long duration shows a limiting periph eral membrane, and closed abscesses con siderable cicatricial tissue: a clear in dication of the tendency to resolution of these abscesses if the general health can be improved.
Pulmonary abscesses may rupture into the pleura, the pericardium, and peri toneum.
Prognosis.—The prognosis of pulmo nary abscess other than that due to tuberculosis has somewhat improved since paracentesis has been introduced. In abscess complicating pneumonia the prognosis is not as unfavorable as would logically appear. The prognosis becomes very unfavorable, however, when pulmo nary abscess occurs as complications of abscesses elsewhere.