Difference between revisions of "Lung abscess"

m (Rossdonaldson1 moved page Lung Abscess to Lung abscess)
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Revision as of 07:14, 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