Difference between revisions of "Lung abscess"

(Causes)
(Background)
Line 2: Line 2:
 
*Localized, suppurative necrotizing process occurring within the pulmonary parenchyma
 
*Localized, suppurative necrotizing process occurring within the pulmonary parenchyma
 
*Microbiology
 
*Microbiology
**Community-acquired: [[anaerobes]] (bacteroides, fusobacterium)
+
**Community-acquired: [[anaerobes]] mostly aspiration, anaerobic bacteria from oral cavity: peptostreptococcus, prevotella, bacteroides, fusobacterium species
 
**Hospital-acquired: [[Staph]], [[E coli]], [[Klebsiella]], [[pseudomonas]], [[legionella]]
 
**Hospital-acquired: [[Staph]], [[E coli]], [[Klebsiella]], [[pseudomonas]], [[legionella]]
  

Revision as of 21:55, 19 August 2019

Background

  • Localized, suppurative necrotizing process occurring within the pulmonary parenchyma
  • Microbiology

Causes

  • Aspiration pneumonia (7-14 days to become lung abscess)
  • Bacteremia from nonpulmonary infection
  • Influenza leading to Bacterial superinfection (e.g. S. Aureus)
  • Pulmonary infarction
  • Infection as a result of penetrating chest trauma
  • Primary and metastatic neoplasms
  • Granulomatosis with polyangiitis (Wegener's), sarcoidosis

Clinical Features

  • Cough, fever, pleuritic chest pain, wt loss, night sweats (generally over course of several weeks)
    • Tachycardia, tachypnea, or fever may be absent

Differential Diagnosis

  • Cavitary lesion with air-fluid level
  • Infected bullae
  • Pleural fluid collection with bronchopleural fistula
  • Loop of bowel extending through diaphragmatic hernia

Evaluation

  • CXR or CT Chest
  • Dense consolidation with air-fluid level inside of a thick-walled cavitary lesion
    • Air-fluid level indicates communication of abscess cavity with a bronchiole

Management

  • Medical management will successfully treat 70-90% of lung abscesses
    • Drainage occurs spontaneously from communication of cavity with tracheobronchial tree
    • Bronchoscopic drainage may result in seeding other parts of the lung
  • Antibiotics

Complications

  • Empyema
  • Massive hemoptysis

Disposition

  • Admit

See Also

References