Lung abscess
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
- Several weeks of cough, fever, pleuritic chest pain, wt loss, night sweats
- 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
- Infected bullae
- Pleural fluid collection with bronchopleural fistula
- 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
Source
Tintinalli