Difference between revisions of "Lung abscess"

(Treatment)
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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
*Takes 7-14d for aspiration PNA to develop into an abscess
 
 
*Microbiology
 
*Microbiology
 
**Community-acquired: [[anaerobes]] (bacteroides, fusobacterium)
 
**Community-acquired: [[anaerobes]] (bacteroides, fusobacterium)
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===Causes===
 
===Causes===
*Aspiration [[PNA]]
+
*Aspiration [[PNA]] (7-14 days to become lung abscess)
 
*Bacteremia from nonpulmonary infection
 
*Bacteremia from nonpulmonary infection
 
*Pulmonary infarction
 
*Pulmonary infarction
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==Clinical Presentation==
 
==Clinical Presentation==
*Several weeks of cough, fever, pleuritic chest pain, wt loss, night sweats
+
*Cough, fever, pleuritic chest pain, wt loss, night sweats (generally over course of several weeks)
 
**Tachycardia, tachypnea, or fever may be absent
 
**Tachycardia, tachypnea, or fever may be absent
  
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*Loop of bowel extending through diaphragmatic hernia
 
*Loop of bowel extending through diaphragmatic hernia
  
==Diagnosis==
+
==Diagnostic Evaluation==
*CXR
+
*CXR or CT Chest
 
*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 communication of abscess cavity with a bronchiole
  
==Treatment==
+
==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 w/ 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==
 
==Complications==
 
*Empyema
 
*Empyema
*Massive Hemoptysis
+
*Massive hemoptysis
*Failure of cavity to resolve
 
  
 
==Disposition==
 
==Disposition==
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*[[Empyema]]
 
*[[Empyema]]
  
==Source==
+
==References==
Tintinalli
+
<References/>
  
 
[[Category:ID]]
 
[[Category:ID]]
 
[[Category:Pulm]]
 
[[Category:Pulm]]

Revision as of 09:17, 6 September 2015

Background

Causes

  • Aspiration PNA (7-14 days to become lung abscess)
  • Bacteremia from nonpulmonary infection
  • Pulmonary infarction
  • Infection as a result of penetrating chest trauma
  • Primary and metastatic neoplasms
  • Wegener's, sarcoidosis

Clinical Presentation

  • Cough, fever, pleuritic chest pain, wt loss, night sweats (generally over course of several weeks)
    • 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

Diagnostic Evaluation

  • CXR or CT Chest
  • Dense consolidation w/ 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 w/ tracheobronchial tree
    • Bronchoscopic drainage may result in seeding other parts of the lung
  • Antibiotics

Complications

  • Empyema
  • Massive hemoptysis

Disposition

  • Admit

See Also

References