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 w/in the pulmonary parenchyma
 +
*Takes 7-14d for aspiration PNA to develop into an abscess
 +
*Microbiology
 +
**Community-acquired: anaerobes (bacteroides, fusobacterium
 +
**Hospital-acquired: Staph, E coli, Klebsiella, pseudomonas, legionella
  
 
==Causes==
 
==Causes==
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==Diagnosis==
 
==Diagnosis==
 
+
*S/S
 +
**Several weeks of cough, fever, pleuritic chest pain, wt loss, night sweats
 +
***Tachycardia, tachypnea, or fever may be absent
 +
*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
  
 
==Work-Up==
 
==Work-Up==
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==DDx==
 
==DDx==
 
+
Cavitary lesion w/ air-fluid level
 +
#Infected bullae
 +
#Pleural fluid collection with bronchopleural fistula
 +
#Loop of bowel extending through diaphragmatic hernia
  
 
==Treatment==
 
==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==
 
==Disposition==
 +
*Admit
  
 
==See Also==
 
==See Also==
 +
[[Empyema]]
  
 
==Source==
 
==Source==
 
+
Tintinalli
  
 
[[Category:ID]]
 
[[Category:ID]]
 
[[Category:Pulm]]
 
[[Category:Pulm]]

Revision as of 01:13, 24 July 2011

Background

  • Localized, suppurative necrotizing process occurring w/in the pulmonary parenchyma
  • Takes 7-14d for aspiration PNA to develop into an abscess
  • Microbiology
    • Community-acquired: anaerobes (bacteroides, fusobacterium
    • Hospital-acquired: Staph, E coli, Klebsiella, pseudomonas, legionella

Causes

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

Diagnosis

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

Work-Up

DDx

Cavitary lesion w/ air-fluid level

  1. Infected bullae
  2. Pleural fluid collection with bronchopleural fistula
  3. Loop of bowel extending through diaphragmatic hernia

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

Empyema

Source

Tintinalli