Lung abscess: Difference between revisions
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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
- 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