Pulmonary abscesses and bronchiectasis

Both primary and secondary pulmonary abscesses are increasingly observed in thoracic surgery units. Primary pulmonary abscesses are related to necroti sing pneumonia or aspiration due to alcoholism, drug abuse, dysphagia or ga strointestinal 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. Bronc hoscopy is mandatory ifa pulmonary abscess is suspected, to exclude endobro nchial obstruction and obtain bacteriological examination by bronchial lava ge or transbronchial fine needle aspiration. Transthoracic fine needle aspi ration may be helpful for bacteriological examination, since germs found in sputum do not necessarily correlate with those found in the abscess. Pulmo nary abscesses are primarily treated by administration of appropriate antib iotics with a remission rate of 80%. In the presence of complications of th e abscess or if conservative management fails, percutaneous transthoracic d rainage or surgical resection may be indicated. Bronchiectasis is also increasingly seen, especially in refugees and immigr ants. The disease is characterised by chronic dilatation of bronchi with pa roxysmal cough, mucopurulent secretion and recurrent pulmonary infections. Bronchiectasis is most commonly caused by recurrent bronchial infections du ring childhood or behind bronchial obstruction. Congenital bronchiectasis i s 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. Bronc hiectasis 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 choic e in situations with well-localised bronchiectasis and results in long-last ing remission in over 80% of those patients. Patients with bilateral bronch iectasis may be considered for bilateral surgical resection if diffuse and congenital disease has been ruled out.