Lung abscess: Difference between revisions
No edit summary |
|||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Localized, suppurative necrotizing process occurring | *Localized, suppurative necrotizing process occurring within the pulmonary parenchyma | ||
*Microbiology | *Microbiology | ||
**Community-acquired: [[anaerobes]] (bacteroides, fusobacterium) | **Community-acquired: [[anaerobes]] (bacteroides, fusobacterium) | ||
| Line 7: | Line 6: | ||
===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 | ||
| Line 15: | Line 14: | ||
==Clinical Presentation== | ==Clinical Presentation== | ||
* | *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 | ||
| Line 24: | Line 23: | ||
*Loop of bowel extending through diaphragmatic hernia | *Loop of bowel extending through diaphragmatic hernia | ||
== | ==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 | **Air-fluid level indicates communication of abscess cavity with a bronchiole | ||
== | ==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 | ||
**[[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 | *Massive hemoptysis | ||
==Disposition== | ==Disposition== | ||
| Line 48: | Line 46: | ||
*[[Empyema]] | *[[Empyema]] | ||
== | ==References== | ||
<References/> | |||
[[Category:ID]] | [[Category:ID]] | ||
[[Category:Pulm]] | [[Category:Pulm]] | ||
Revision as of 09:17, 6 September 2015
Background
- Localized, suppurative necrotizing process occurring within the pulmonary parenchyma
- Microbiology
- Community-acquired: anaerobes (bacteroides, fusobacterium)
- Hospital-acquired: Staph, E coli, Klebsiella, pseudomonas, legionella
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
- Clindamycin + 2nd or 3rd gen cephalosporin OR
- Clindamycin + ampicillin/sulbactam
Complications
- Empyema
- Massive hemoptysis
Disposition
- Admit