Abscess Of The Lung


Categories: BRONCHOSCOPY IN DISEASES OF THE TRACHEA AND BRONCHI
Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

If of foreign-body origin, pulmonary abscess

almost invariably heals after the removal of the object and a regime

of fresh air and rest, without local measures of any kind. Acute

pulmonary abscess from other causes may require bronchoscopic drainage

and gentle dilatation of the swollen and narrowed bronchi leading to

it. Some of these bronchi are practically fistulae. Obstructive

granulations should be removed with crushing, not biting forceps. The

regular foreign-body forceps are best for this purpose. Caution should

be used as to removal of the granulations with which the abscess

cavity is filled in chronic cases. The term abscess is usually

loosely applied to the condition of drowned lung in which the pus has

accumulated in natural passages, and in which there is neither a new

wall nor a breaking down of normal walls. Chronic lung-abscess is

often successfully treated by weekly bronchoscopic lavage with 20 cc.

or more of a warm, normal salt solution, a 1:1000 watery potassium

permanganate solution, or a weak iodine solution as in the following

formula:

Rx. Monochlorphenol (Merck) .12

Lugol's solution 8.00

Normal salt solution 500.



Perhaps the best procedure is to precede medicinal applications by the

clearing out of the purulent secretions by aspiration with the

aspirating bronchoscope and the independent aspirating tube, the

latter being inserted into passages too small to enter with the

bronchoscope, and the endobronchial instillation of from 10 to 30 cc.

of the medicament. The following have been used: Argyrol, 1 per cent

watery solution; Silvol, 1 per cent watery solution; Iodoform, oil

emulsion 10 per cent; Guaiacol, 10 per cent solution in paraffine oil;

Gomenol, 20 per cent solution in oil; or a bismuth subnitrate

suspension in oil. Robert M. Lukens and William F. Moore of the

Bronchoscopic Clinic report excellent results in post-tonsillectomy

abscesses from one tenth of one per cent phenol in normal salt

solution with the addition of 2 per cent Lugol's solution. Chlorinated

solutions are irritating, and if used, require copious dilution.

Liquid petrolatum with a little oil of eucalyptus has been most often

the medium.





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