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Extract a tooth, the right lung will rot, what to do?

 Last Update: 2023-01-06
 Source: Internet
 Author: User

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What is this "magical" operation?

preface

Tooth extraction is a very common operation
.
However, rarely, tooth extractions can cause life-threatening lung infections
.
A 45-year-old male patient had chest pain, fever, difficulty breathing after tooth extraction, and his entire right lung was basically rotten
.

What's going on here? What is the next step in treatment?

Case introduction

: 45-year-old man, Pingsu has teeth checked every six months, no caries, bad breath, recent wisdom tooth extraction, slight inflammation of the gums at the wisdom tooth site, However, no signs of
infection were observed at the time of tooth extraction.
Postoperative oral cefoperixil (third-generation cephalosporins) resulted in right chest pain 2 days after tooth extraction, persistent fever and dyspnea 2 weeks after tooth extraction, with cough and purulent sputum
.

Anamnesis: The patient does not have any history of medical abnormalities and does not take routine medications
.
In addition, he underwent a medical examination every year and did not find anything abnormal.

No history
of alcohol or smoking.
His recent physical examination showed no abnormalities
in the chest radiograph.
On blood tests 2 months before the onset of symptoms, blood counts and biochemical results, including glycated hemoglobin, are within the normal range
.
At that time, upper gastrointestinal endoscopy was normal on stomach and esophagus, and there was no reflux esophagitis
.

Figure 01
Physical examination: Height 1.
72 meters, weight 58.
4 kg (BMI, 19.
7), body temperature 40.
5 °C, oxygen intake 15 L/min conditions, blood oxygen saturation 87%, blood pressure 144/92mmHg, heart rate 146 beats/min, respiratory rate 42 times/min, bad breath, but no signs of inflammation or infection in the mouth, including the tooth extraction site, weak breath sounds on the right side, rough crackling sounds on the left side, abdomen, skin and lymph nodes are normal
.

Ancillary examination: arterial blood gas analysis at 15 L/min of oxygen showed PO2 of 60.
6 mmHg
.
The white blood cell count was 7.
8×10 ³/microliter (7.
8×10⁹/L), with 87.
8% neutrophils, 121 g/L of hemoglobin, and 511×10 platelets³ /μL (511×10⁹/L), C-reactive protein 34.
4 mg/dL
。 Renal function, liver function, glycated hemoglobin, HIV antigen antibodies, anti-human T-cell leukemia virus type 1 antibodies, C3, C4, and CH50, gamma globulins (IgG, IgA, IgM), and autoantibodies (antinuclear antibodies, rheumatoid factor, and antineutrophil cytoplasmic antibodies) are within the normal range
.

Chest x-ray shows a large lung abscess
in the right lung.

Figure 02

During the diagnosis and treatment

of hypoxemia, respiratory rate 42 times/min, oxygen inhalation 15 L/min lower arterial blood PO 2 was 60.
6mmHg and was given ventilator
.

CT of the chest shows a huge lung abscess
in the right lung.
Figure 03
In a patient with high fever, respiratory failure, and a large lung abscess, ultrasound-guided chest puncture placed a chest drainage tube drained a total of 1200 mL of cloudy blood liquid with a rancid odor and a pH below 6.
49
.

Pus is cultured to anaerobic bacteria, which are all anaerobes colonized by the mouth
.

Anaerobes prefer metronidazole? NO！
Many antibiotics can treat anaerobic bacteria!
Give ampicillin sulbactam + clindamycin anti-anaerobic bacteria!
Bronchoscopy shows cloudy pus transferred from the right bronchi to the left bronchi, indicating that respiratory failure was caused
by the spread of inflammation.

After 10 days of treatment, the chest closed drainage tube was removed and the ventilator
was removed.

After 2 months of antibiotic therapy, chest CT showed a narrowing of the right cavity and still infiltrates
on the left.

Figure 04
Tooth extraction can cause lung infection, even if the patient usually has good oral hygiene, even if the operation is strictly aseptic, even if antibiotics are given after surgery
。
Percutaneous drainage of lung abscess (PTD)
may be considered in rare cases if the patient has a severe lung abscess with a large cavitation or if antibiotic therapy has failed.
Despite complications such as bleeding, pneumothorax, and bronchopleural fistula, PTD has an overall success rate of 84%, a complication rate of 16%, and a mortality rate of 4%, suggesting that PTD is a highly effective surgical approach
for the treatment of severe and large lung abscesses.
However, you know, this 4% mortality rate is still quite heart-wrenching, and it is easy to get into a lawsuit if you are unlucky
.

More practical respiratory cases? Come to the "Doctor Station APP" and take a look 👇

at the references: [1] Hiroki,Tashiro,Koichiro,et al.
A 45-Year-Old Man With Acute Chest Pain, Fever, and Dyspnea After Tooth Extraction[J].
Chest,2021,160(6):e623-e628.
DOI:10.
1016/j.
chest.
2021.
07.
049.

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