Difference between revisions of "Lung abscess"

(Created page with "==Background== *Localized, suppurative necrotizing process occurring w/in the pulmonary parenchyma ==Causes== *Aspiration PNA *Bacteremia from nonpulmonary infection *Pulmonary ...")
 
 
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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
 +
*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==
+
===Causes===
*Aspiration PNA
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*Aspiration [[pneumonia]] (7-14 days to become lung abscess)
*Bacteremia from nonpulmonary infection
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*[[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]]
  
==Diagnosis==
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==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===
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*[[Empyema]]
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*Massive [[hemoptysis]]
  
==Work-Up==
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==Differential Diagnosis==
 +
*Cavitary lesion with air-fluid level
 +
*Infected bullae
 +
*Pleural fluid collection with bronchopleural fistula
 +
*Loop of bowel extending through diaphragmatic hernia
  
 +
==Evaluation==
 +
[[File:PulmonaryabsCXR.png|thumb|Pulmonary abscess on [[CXR]]]]
 +
[[File:Pulmonaryabs.png|thumb|Pulmonary abscess on CT scan]]
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*[[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
  
==DDx==
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==Management==
 
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*Medical management will successfully treat 70-90% of lung abscesses
 
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**Drainage occurs spontaneously from communication of cavity with tracheobronchial tree
==Treatment==
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**Bronchoscopic drainage may result in seeding other parts of the lung
 
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*Antibiotics
 +
**[[Clindamycin]] + 2nd or 3rd gen [[cephalosporin]] '''OR'''
 +
**[[Clindamycin]] + [[ampicillin/sulbactam]]
  
 
==Disposition==
 
==Disposition==
 +
*Admit
  
 
==See Also==
 
==See Also==
 +
*[[Empyema]]
  
==Source==
+
==References==
 
+
<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