1. LUNG GANGRENE

2. Lung gangrene is the process of destruction of the bronchi and lung tissue over a large area of ​​a purulent and putrefactive nature with a tendency to expand the boundaries. Purulent tissue fusion is not limited to one area. The pathological process is capable of spreading rapidly, covering new zones. The disease can affect several lobes, sometimes it spreads to the whole lung

3. One of the most severe pulmonary diseases is lung gangrene. It leads to the destruction of the respiratory system and the development of multiple organ failure. The affected tissue is brown. Fetid pus is localized inside. Necrosis does not have strict outlines, and tends to grow. Pathology is divided into 2 types: Common: localization of the disease is observed lobar. Limited: Segmental arrangement is detected. Often this process is characterized as an abscess, which is gangrenous in nature. Most often, the disease is diagnosed in middle-aged men. Lung tissue is very loose, easily disintegrates, and then melts, turning into a homogeneous mass with a fetid odor.

4. CAUSES The causative agents of lung gangrene, as a rule, are microbial associations, including anaerobic micro flora. Among the etiologically significant agents in bacterial cultures, pneumococcus, Haemophilus influenza etc. The aetiology of the disease is as follows: Diseases of the gums, teeth, nasopharynx can provoke the ingress of microbes into the lungs and bronchi. In such conditions, the pathogenic micro flora is able to spread down the respiratory tract. Sometimes there is penetration into the respiratory organs of a microscopic amount of discharge from the nasopharynx or stomach contents during reflux, dysphagia, during vomiting. The latter phenomenon is often provoked by craniocerebral trauma or alcohol intoxication. The aggressive contents of the stomach penetrated into the bronchi causes a purulent- necrotic process in the tissues

5. CLASSIFICATION According to the mechanism of development, the following forms of lung gangrene are distinguished: bronchogenic (post-pneumonic, aspiration, obstructive); thromboembolic; post-traumatic; haematogenous lymphogenous. According to the involvement of lung tissues, subtotal lobar total bilateral lung gangrene

6. Pathology may be the result of insufficient ventilation. This condition often occurs when the bronchi are compressed by a foreign body or tumour. Microbes appear in this area, and abscess and gangrene begin to form. The cause of the development of pathology can be purulent ailments of the Broncho pulmonary system. We are talking about the following diseases: bronchiectasis, pneumonia, lung abscess. The traumatic mechanism of gangrene development is also distinguished. An infection in the chest can be caused by penetrating wounds. Pathogenic micro flora can spread to the lungs through the system of lymphatic and blood vessels. This is observed in osteomyelitis, sepsis, parotitis, angina and many other pathologies. The aspiration mechanism of pulmonary gangrene is associated with micro aspiration of secretions from the nasopharynx, upper respiratory tract, and stomach contents into the respiratory tract. A similar picture can be observed in the following cases: with aspiration pneumonia; in conditions caused by anesthesia, alcohol, craniocerebral trauma; with dysphagia, gastroesophageal reflux.

7. PATHOGENESIS  Waste products of pyogenic micro flora and vascular thrombosis lead to massive melting of the pulmonary parenchyma, which has no clear boundaries.  In the zones of necrosis, cavities are formed, which merge with each other when enlarged.  The rejected tissue can be partially drained through the bronchi.  Extensive destruction of the lung parenchyma in gangrene of the lung is accompanied by the absorption of bacterial toxins and putrefactive decay products, leading to the formation of inflammatory mediators (pro- inflammatory cytokines) and active radicals, which is accompanied by an even greater increase in proteolysis, expansion of the tissue destruction zone, and an increase in intoxication.

8. SYMPTOMS Painful discomfort in the sternum. It intensifies significantly during coughing. Severe condition of the patient: high fever(39-40 ° C), chills, pronounced intoxication of the body. There is a lack of appetite, weight loss, up to anorexia, tachycardia, shortness of breath. Intense cough accompanied by frothy expectoration and pus. The discharge has a fetid odour. They have a brown tint and contain a foamy layer. With gangrene of the lung, particles of dead tissue and blood can be found in sputum. The patient begins to choke. Respiratory rate more than 20 per minute, cyanosis of the tip of the nose, earlobes, palms, feet. Profuse sweating is observed. Lack of oxygen leads to hypoxia, which is manifested by cyanosis of the fingers, skin, lips. The patient gets tired quickly. Clouding of consciousness is sometimes observed. A deep breath is painfully given to the patient. Calm breathing does not cause discomfort.

9. RISK FACTORS smoking; alcoholism; addiction; HIV infection; old age; the use of glucocorticoid hormones; diabetes.

10. DIAGNOSIS Physical examination plays an essential role in determining pathology. The patient has a lag in the breathing process of the affected part of the chest, the percussion sound is shortened. During auscultation, weakened breathing sounds, dry rales are found. In addition, the diagnosis of lung gangrene includes instrumental and laboratory research methods: 1.Blood test. It shows an increase in the number of leukocytes, a decreased level of erythrocytes, an increase in ESR. There is a decrease in total blood protein. 2.X-ray of the sternum. Gangrene and necrosis of the lung are manifested in the image by darkening of the tissue. Cavities with irregular or scalloped edges are often found. Darkening tends to spread rapidly and over several days can affect the adjacent lobes, and sometimes the whole lung. X-rays show the occurrence of pleural effusion.

11. 3. CT scan. This is a modern X-ray method. It is especially informative for this pathology. The tomogram allows you to detect all decay cavities that correspond to the melting zones of the lungs. 4.Fibrobronchoscopy. The endoscopic diagnostic method determines purulent endobronchitis, obstruction. The study makes it possible to observe the dynamics of the pathological process. 5.Sputum analysis. After bronchoscopy, the contents and sputum are sent for laboratory tests. Diagnostic tests identify the causative agent of the pathology and allow you to determine the sensitivity of microorganisms to antibiotics.

12. TREATMENT  The main task is to combat intoxication of the body and restore the water and electrolyte balance. For this, massive infusion therapy is carried out with intravenous administration of blood plasma, plasma-substituting solutions, water-electrolyte mixtures, protein solutions. The main role in conservative treatment is assigned to antibiotic therapy. Usually, a combination of several antimicrobial drugs is used at maximum dosages.  In complex treatment, desensitizing and vitamin preparations, anticoagulants and respiratory analeptics, immunomodulators, and means for maintaining the activity of the heart and blood vessels are used. Efferent methods of treatment, inhalation of oxygen, proteolytic enzymes, bronchodilators using a nebulizer are widely used.

13. A patient with gangrene of the lung undergoes oxygen therapy, plasmapheresis, inhalations with proteolytic enzymes and bronchodilators are prescribed. Antimicrobial therapy is central to the conservative treatment of lung gangrene. It involves the use of a combination of two broad-spectrum antibacterial drugs in maximum dosages. In the treatment of lung gangrene, parenteral (intravenous, intramuscular) and local administration of antibiotics (in the bronchial tree, pleural cavity) are combined. therapeutic bronchoscopy is performed with aspiration of secretions, bronchoalveolar lavage, and the administration of antibiotics. With the development of pleurisy, a puncture of the pleural cavity is performed with the removal of exudate.

14. Essential drugs Thienam (antibiotic of the carbapenem group) Cefepim (antibiotic from the group of IV generation cephalosporin). Fluconazole (antifungal drug) Human immunoglobulin is normal (a drug for the treatment of immunodeficiency). Ambroxol ( Ambrobene, Lazolvan, Haliksol) is a mucolytic and expectorant drug. Acetyl cysteine ​​sodium ( ACC Inject ) is a mucolytic drug.

15. COMPLICATIONS Lung gangrene is an extremely dangerous disease. It often leads to fatal complications: purulent destruction of the pleura; pulmonary bleeding; suppuration of the chest wall; sepsis; multiple organ failure. About 60% of patients who experience such consequences die

16. FORECAST AND PREVENTATION Despite the success of thoracic surgery, the mortality rate in lung gangrene remains high - at the level of 25-40%. Most often, the death of patients occurs due to pneumogenic sepsis, multiple organ failure, and pulmonary haemorrhage. Only a timely started complex intensive therapy, supplemented, if necessary, by a radical operation, can count on a favourable outcome. Prevention of lung gangrene is a complex medical and social task, which includes measures for health education, raising the standard of living of the population, fighting bad habits, organizing timely medical care for various infectious and purulent-septic diseases.

17. RECOMMENDATIONS Consultation with a pulmonologist. Consultation with a thoracic surgeon. Radiography of the lungs. General sputum analysis.

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