Difference between revisions of "Lung abscess"
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==Background== | ==Background== | ||
| − | *Localized, suppurative necrotizing process occurring | + | *Localized, suppurative necrotizing process occurring within the pulmonary parenchyma |
| − | |||
*Microbiology | *Microbiology | ||
| − | **Community-acquired: [[anaerobes]] | + | **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 [[ | + | *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 | + | *[[Granulomatosis with polyangiitis]] (Wegener's), [[sarcoidosis]] |
| − | ==Clinical | + | ==Clinical Features== |
| − | * | + | *[[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 | + | *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 | ||
| − | == | + | ==Evaluation== |
| − | *CXR | + | [[File:PulmonaryabsCXR.png|thumb|Pulmonary abscess on [[CXR]]]] |
| − | *Dense consolidation | + | [[File:Pulmonaryabs.png|thumb|Pulmonary abscess on CT scan]] |
| − | **Air-fluid level indicates | + | *[[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 | *Medical management will successfully treat 70-90% of lung abscesses | ||
| − | **Drainage occurs spontaneously from communication of cavity | + | **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 | ||
| − | * | + | *Antibiotics |
| − | **[[Clindamycin]] + 2nd or 3rd gen [[cephalosporin]] OR | + | **[[Clindamycin]] + 2nd or 3rd gen [[cephalosporin]] '''OR''' |
**[[Clindamycin]] + [[ampicillin/sulbactam]] | **[[Clindamycin]] + [[ampicillin/sulbactam]] | ||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
==Disposition== | ==Disposition== | ||
| Line 48: | Line 49: | ||
*[[Empyema]] | *[[Empyema]] | ||
| − | == | + | ==References== |
| − | + | <References/> | |
[[Category:ID]] | [[Category:ID]] | ||
| − | [[Category: | + | [[Category:Pulmonary]] |
Latest revision as of 15:41, 9 October 2019
Contents
Background
- Localized, suppurative necrotizing process occurring within the pulmonary parenchyma
- Microbiology
- Community-acquired: anaerobes mostly aspiration, anaerobic bacteria from oral cavity: peptostreptococcus, prevotella, bacteroides, fusobacterium species
- Hospital-acquired: Staph, E coli, Klebsiella, pseudomonas, legionella
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, weight loss, night sweats (generally over course of several weeks)
- Tachycardia, tachypnea, or fever may be absent
Complications
- Empyema
- Massive hemoptysis
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
- 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
- Clindamycin + 2nd or 3rd gen cephalosporin OR
- Clindamycin + ampicillin/sulbactam
Disposition
- Admit