Both primary and secondary
pulmonary abscesses are increasingly observed in thoracic surgery units. Primary
pulmonary abscesses are related to necrotising
pneumonia or aspiration due to
alcoholism,
drug abuse,
dysphagia or gastrointestinal reflux disease. Secondary poststenotic
abscesses are related to bronchial obstruction (endobronchial tumour or
foreign body aspiration) or to
superinfection of pulmonary
neoplasia or
infarction pneumonia. Bronchoscopy is mandatory if a
pulmonary abscess is suspected, to exclude endobronchial obstruction and obtain bacteriological examination by bronchial lavage or transbronchial fine needle aspiration. Transthoracic fine needle aspiration may be helpful for bacteriological examination, since germs found in sputum do not necessarily correlate with those found in the
abscess.
Pulmonary abscesses are primarily treated by administration of appropriate
antibiotics with a remission rate of 80%. In the presence of complications of the
abscess or if
conservative management fails, percutaneous transthoracic drainage or surgical resection may be indicated.
Bronchiectasis is also increasingly seen, especially in refugees and immigrants. The disease is characterised by chronic dilatation of bronchi with paroxysmal
cough, mucopurulent secretion and recurrent pulmonary
infections.
Bronchiectasis is most commonly caused by recurrent bronchial
infections during childhood or behind bronchial obstruction. Congenital
bronchiectasis is very rare. Viral and bacterial pulmonary
infections during childhood are by far the most common causes of
bronchiectasis, leading to destruction of the mucociliary apparatus and the cartilage of the segmental bronchi.
Bronchiectasis should be treated by an appropriate
antibiotic regimen. Resection should only be considered in situations where a conservative regimen fails.
Segmentectomy of all involved segments is the surgical treatment of choice in situations with well-localised
bronchiectasis and results in long-lasting remission in over 80% of those patients. Patients with bilateral
bronchiectasis may be considered for bilateral surgical resection if diffuse and congenital disease has been ruled out.