Difference between revisions of "Lung abscess"

 
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==Background==
 
==Background==
*Localized, suppurative necrotizing process occurring w/in the pulmonary parenchyma
+
*Localized, suppurative necrotizing process occurring within the pulmonary parenchyma
*Takes 7-14d for aspiration PNA to develop into an abscess
 
 
*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]]
  
 
===Causes===
 
===Causes===
*Aspiration [[PNA]]
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*Aspiration [[pneumonia]] (7-14 days to become lung abscess)
*Bacteremia from nonpulmonary infection
+
*[[Bacteremia]] from nonpulmonary infection
 +
*[[Influenza]] leading to Bacterial superinfection (e.g. ''S. Aureus'')
 
*Pulmonary infarction
 
*Pulmonary infarction
*Infection as a result of penetrating chest trauma
+
*Infection as a result of penetrating [[chest trauma]]
 
*Primary and metastatic neoplasms
 
*Primary and metastatic neoplasms
*Wegener's, sarcoidosis
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*[[Granulomatosis with polyangiitis]] (Wegener's), [[sarcoidosis]]
  
==Clinical Presentation==
+
==Clinical Features==
*Several weeks of cough, fever, pleuritic chest pain, wt loss, night sweats
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*[[Cough]], [[fever]], pleuritic [[chest pain]], weight loss, night sweats (generally over course of several weeks)
**Tachycardia, tachypnea, or fever may be absent
+
**[[Tachycardia]], [[tachypnea]], or [[fever]] may be absent
 +
 
 +
===Complications===
 +
*[[Empyema]]
 +
*Massive [[hemoptysis]]
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
*Cavitary lesion w/ air-fluid level
+
*Cavitary lesion with air-fluid level
 
*Infected bullae
 
*Infected bullae
 
*Pleural fluid collection with bronchopleural fistula
 
*Pleural fluid collection with bronchopleural fistula
 
*Loop of bowel extending through diaphragmatic hernia
 
*Loop of bowel extending through diaphragmatic hernia
  
==Diagnosis==
+
==Evaluation==
*CXR
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[[File:PulmonaryabsCXR.png|thumb|Pulmonary abscess on [[CXR]]]]
*Dense consolidation w/ air-fluid level inside of a thick-walled cavitary lesion
+
[[File:Pulmonaryabs.png|thumb|Pulmonary abscess on CT scan]]
**Air-fluid level indicates communicatio nof abscess cavity w/ a bronchiole
+
*[[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
  
==Treatment==
+
==Management==
 
*Medical management will successfully treat 70-90% of lung abscesses
 
*Medical management will successfully treat 70-90% of lung abscesses
**Drainage occurs spontaneously from communication of cavity w/ tracheobronchial tree
+
**Drainage occurs spontaneously from communication of cavity with tracheobronchial tree
 
**Bronchoscopic drainage may result in seeding other parts of the lung
 
**Bronchoscopic drainage may result in seeding other parts of the lung
*Abx
+
*Antibiotics
**Clindamycin + 2nd or 3rd gen cephalosporin OR
+
**[[Clindamycin]] + 2nd or 3rd gen [[cephalosporin]] '''OR'''
**Clindamycin + ampicillin/sulbactam
+
**[[Clindamycin]] + [[ampicillin/sulbactam]]
 
 
==Complications==
 
*Empyema
 
*Massive Hemoptysis
 
*Failure of cavity to resolve
 
  
 
==Disposition==
 
==Disposition==
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*[[Empyema]]
 
*[[Empyema]]
  
==Source==
+
==References==
Tintinalli
+
<References/>
  
 
[[Category:ID]]
 
[[Category:ID]]
[[Category:Pulm]]
+
[[Category:Pulmonary]]

Latest revision as of 15:41, 9 October 2019

Background

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

Causes

Clinical Features

Complications

Differential Diagnosis

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

Evaluation

Pulmonary abscess on CXR
Pulmonary abscess on CT scan
  • 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

Disposition

  • Admit

See Also

References