Difference between revisions of "Lung abscess"

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*Takes 7-14d for aspiration PNA to develop into an abscess
 
*Takes 7-14d for aspiration PNA to develop into an abscess
 
*Microbiology
 
*Microbiology
**Community-acquired: anaerobes (bacteroides, fusobacterium
+
**Community-acquired: [[anaerobes]] (bacteroides, fusobacterium)
**Hospital-acquired: Staph, E coli, Klebsiella, pseudomonas, legionella
+
**Hospital-acquired: [[Staph]], [[E coli]], [[Klebsiella]], [[pseudomonas]], [[legionella]]
  
==Causes==
+
===Causes===
*Aspiration PNA
+
*Aspiration [[PNA]]
 
*Bacteremia from nonpulmonary infection
 
*Bacteremia from nonpulmonary infection
 
*Pulmonary infarction
 
*Pulmonary infarction
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*Primary and metastatic neoplasms
 
*Primary and metastatic neoplasms
 
*Wegener's, sarcoidosis
 
*Wegener's, sarcoidosis
 +
 +
==Clinical Presentation==
 +
*Several weeks of cough, fever, pleuritic chest pain, wt loss, night sweats
 +
**Tachycardia, tachypnea, or fever may be absent
 +
 +
==Differential Diagnosis==
 +
*Cavitary lesion w/ air-fluid level
 +
*Infected bullae
 +
*Pleural fluid collection with bronchopleural fistula
 +
*Loop of bowel extending through diaphragmatic hernia
  
 
==Diagnosis==
 
==Diagnosis==
*S/S
 
**Several weeks of cough, fever, pleuritic chest pain, wt loss, night sweats
 
***Tachycardia, tachypnea, or fever may be absent
 
 
*CXR
 
*CXR
 
*Dense consolidation w/ air-fluid level inside of a thick-walled cavitary lesion
 
*Dense consolidation w/ air-fluid level inside of a thick-walled cavitary lesion
 
**Air-fluid level indicates communicatio nof abscess cavity w/ a bronchiole
 
**Air-fluid level indicates communicatio nof abscess cavity w/ a bronchiole
 
==Work-Up==
 
 
 
==DDx==
 
Cavitary lesion w/ air-fluid level
 
#Infected bullae
 
#Pleural fluid collection with bronchopleural fistula
 
#Loop of bowel extending through diaphragmatic hernia
 
  
 
==Treatment==
 
==Treatment==
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==See Also==
 
==See Also==
[[Empyema]]
+
*[[Empyema]]
  
 
==Source==
 
==Source==

Revision as of 07:13, 1 May 2015

Background

  • Localized, suppurative necrotizing process occurring w/in the pulmonary parenchyma
  • Takes 7-14d for aspiration PNA to develop into an abscess
  • Microbiology

Causes

  • Aspiration PNA
  • Bacteremia from nonpulmonary infection
  • Pulmonary infarction
  • Infection as a result of penetrating chest trauma
  • Primary and metastatic neoplasms
  • Wegener's, sarcoidosis

Clinical Presentation

  • Several weeks of cough, fever, pleuritic chest pain, wt loss, night sweats
    • Tachycardia, tachypnea, or fever may be absent

Differential Diagnosis

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

Diagnosis

  • CXR
  • Dense consolidation w/ air-fluid level inside of a thick-walled cavitary lesion
    • Air-fluid level indicates communicatio nof abscess cavity w/ a bronchiole

Treatment

  • Medical management will successfully treat 70-90% of lung abscesses
    • Drainage occurs spontaneously from communication of cavity w/ tracheobronchial tree
    • Bronchoscopic drainage may result in seeding other parts of the lung
  • Abx
    • Clindamycin + 2nd or 3rd gen cephalosporin OR
    • Clindamycin + ampicillin/sulbactam

Complications

  • Empyema
  • Massive Hemoptysis
  • Failure of cavity to resolve

Disposition

  • Admit

See Also

Source

Tintinalli