Segmental pneumonia is an inflammation of the morphofunctional unit of the lung lobe – the bronchopulmonary segment. The disease occurs more often in children. Segmental pneumonia is characterized by an acute onset, high fever, severe intoxication, staccato cough, chest or abdominal pain. It can take a prolonged course, lead to the formation of pneumosclerosis and bronchiectasis. Segmental pneumonia is diagnosed according to clinical, physical, radiological and laboratory data. Treatment of segmental pneumonia consists of antibiotic therapy, detoxification, oxygen therapy, elimination of bronchial obstruction and cardiovascular disorders.
J18.8 Other pneumonia, the causative agent is not specified
Segmental pneumonia is a delimited inflammation that covers the lung tissue within the boundaries of one or more anatomical segments. Segmental pneumonia is more common in preschool children (3-7 years old), but the disease can also affect children of other age groups, and even adults. Disease accounts for about 25% of all acute pneumonia in children. In terms of frequency of development, it is second only to focal pneumonia. With simultaneous lesion of several segments, they speak of polysegmental pneumonia; parts of the pulmonary segment – of subsegmental pneumonia.
There are primary segmental pneumonia (occurs as an independent disease) and secondary (develops against the background of ARVI). Due to the fact that segmental pneumonia is prone to torpid and complicated course, its timely recognition and adequate therapy are an urgent task of pulmonology and pediatrics.
Causes of segmental pneumonia
The microbial landscape in primary form is usually represented by pneumococci, hemophilic bacillus, pyogenic streptococcus, Staphylococcus. Mixed infections (a combination of several bacterial agents) are common. From atypical pathogens, chlamydia, mycoplasma, legionella can lead to the formation of segmental inflammation of the lungs. Respiratory viruses occupy a significant place in the etiology of segmental pneumonia: influenza, parainfluenza, MS virus, adenovirus.
The ways of penetration and spread of infection are typical for other types of pneumonia – aerosol (when pathogens are inhaled together with air), aspiration (when pathogens enter from the nasopharynx), hematogenic (when pathogens spread from other foci of infection in the body).
Segmental type pneumonia usually affects children:
- those with a tendency to hyperergic reactions
- suffering from manifestations of exudative-catarrhal diathesis.
In adults , predisposing factors may be:
- chronic deforming bronchitis
- reduction of the overall immune defense.
Bronchopulmonary segments are areas of lung tissue that are part of the lobe, which are ventilated by their own segmental bronchi and are supplied with blood by segmental branches of the pulmonary artery. The segments have the shape of a truncated cone, with the tip facing the root of the lung. There are ten segments in each lung (some authors distinguish eight segments in the left lung). The upper lobe of the right lung consists of three segments (apical, posterior and anterior); the middle lobe consists of two segments (lateral and medial); the lower one consists of five segments (upper, medial basal, anterior basal, lateral basal, posterior basal). The upper lobe of the left lung is formed by five segments (apical, posterior, anterior, upper lingual and lower lingual); the segments of the lower lobe of the left lung coincide with those in the right lung.
Local inflammation of one or more of the listed anatomical sections of the respiratory tract causes the development of segmental pneumonia, i.e. the lesion always covers less than an entire fraction. The segments involved in the inflammatory process, as a rule, are in a state of atelectasis. Right-sided segmental pneumonia occurs more often. In 95% the process is unilateral, only in 5% the pulmonary segments are affected from both sides.
Symptoms of segmental pneumonia
The disease manifests acutely: body temperature reaches 39 ° C, there is a pronounced intoxication syndrome (bruising, sweating, adynamia, body aches, headache), tachypnea, tachycardia. Children may experience confusion, convulsions. On the second or third day of the disease, a rare staccato cough, pain in the chest and in the epigastric region joins. With polysegmental pneumonia, these symptoms are more pronounced, respiratory failure develops rapidly.
With timely treatment, clinical signs of segmental pneumonia regress after 10-12 days, but radiological changes persist for a longer time – two to three weeks. Since the affected pulmonary segment, as a rule, is in a state of atelectasis, segmental pneumonia can acquire a torpid course and be delayed for 2-3 months. Unresolved acute segmental pneumonia can lead to the development of chronic pneumonia, local pneumosclerosis and bronchiectasis.
Complications of polysegmental pneumonia include obstructive syndrome, serous and fibrinous pleurisy, pleural empyema, and lung abscess. The accumulation of viral and bacterial toxins in the blood and tissues has a damaging effect, primarily on the cardiovascular system and the central nervous system, causing toxic complications: acute heart failure, arterial hypotension, collapse, cardiovascular syndrome, neurotoxicosis.
About a quarter of patients in the first days of the disease have poor auscultative and percussion data. In other cases, a pediatrician or a pulmonologist may suspect segmental pneumonia by combining clinical symptoms with physical changes: persistent moist small-bubbly wheezing, bronchial breathing, shortening of percussion sound.
Diagnostic assumptions are confirmed on the basis of lung x-ray data: homogeneous intense shadows in the shape of a triangle with clearly defined boundaries, a decrease in the structure of the root are revealed on the images. Sometimes segmental pneumonia can be detected only by dynamic examination, when an atelectatic component appears, giving the boundaries of the lesion a characteristic clarity. Acute inflammatory changes are detected in peripheral blood, including leukocytosis, a shift of the formula to the left, an increase in ESR, a tendency to anemia.
Segmental pneumonia is differentiated with pulmonary tuberculosis, primary and metastatic lung cancer, lung infarction, obliterating bronchiolitis, a foreign body in the bronchi, as well as other clinical and radiological forms of pneumonia (focal, lobar, interstitial).
Treatment of segmental pneumonia
Segmental pneumonia therapy is aimed at combating the infectious onset, eliminating respiratory failure, reducing toxic load, resorption of inflammatory foci in the lungs. Children with a burdened premorbid background, severe, complicated and prolonged course of segmental pneumonia are subject to hospitalization, in other cases, therapy can be carried out on an outpatient basis.
Etiotropic antibacterial therapy begins immediately after diagnosis and lasts 10-14 days. Starting therapy is carried out with broad-spectrum drugs (semi-synthetic penicillins, cephalosporins, fluoroquinolones).
Sanitation of the respiratory tract. Expectorants and mucolytics, bronchodilators are prescribed in order to eliminate obstruction of the respiratory tract, therapeutic bronchoscopies, ultrasound inhalations are performed.
Post-syndrome therapy is aimed at restoring impaired functions, using antipyretics, sedatives, cardiovascular, antihistamines, glucocorticosteroids. For detoxification purposes, intravenous infusions of glucose-salt solutions are performed; the introduction of calcium chloride contributes to the resorption of infiltrative changes. With severe respiratory insufficiency, systematic oxygen therapy is prescribed.
Physical therapy. In the period of reverse development of segmental pneumonia, drug treatment is supplemented by methods of physiotherapy: UHF, inductothermy, drug electrophoresis, UFO on the chest. To improve the drainage of the bronchial tree, vibration massage, breathing exercises, chest massage are indicated.
Mild and moderate forms of segmental pneumonia, as a rule, end in complete recovery within three weeks. Prolonged or complicated course is usually observed with viral or bacterial reinfection, burdened premorbid background, late or inadequate treatment. With the development of toxic or purulent complications, the prognosis of segmental pneumonia can be very serious.