Lung abscess

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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