Lung abscess: Difference between revisions

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*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]]


===Causes===
===Causes===
*Aspiration [[PNA]] (7-14 days to become lung abscess)
*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 Presentation==
==Clinical Features==
*Cough, fever, pleuritic chest pain, wt loss, night sweats (generally over course of several weeks)
*[[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


==Diagnostic Evaluation==
==Evaluation==
*CXR or CT Chest
[[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 communication of abscess cavity with 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


==Management==
==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
*Antibiotics
*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


==Disposition==
==Disposition==
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[[Category:ID]]
[[Category:ID]]
[[Category:Pulm]]
[[Category:Pulmonary]]

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