Lung abscess: Difference between revisions
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*Takes 7-14d for aspiration PNA to develop into an abscess | *Takes 7-14d for aspiration PNA to develop into an abscess | ||
*Microbiology | *Microbiology | ||
**Community-acquired: anaerobes (bacteroides, fusobacterium | **Community-acquired: [[anaerobes]] (bacteroides, fusobacterium) | ||
**Hospital-acquired: Staph, E coli, Klebsiella, pseudomonas, legionella | **Hospital-acquired: [[Staph]], [[E coli]], [[Klebsiella]], [[pseudomonas]], [[legionella]] | ||
==Causes== | ===Causes=== | ||
*Aspiration PNA | *Aspiration [[PNA]] | ||
*Bacteremia from nonpulmonary infection | *Bacteremia from nonpulmonary infection | ||
*Pulmonary infarction | *Pulmonary infarction | ||
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*Primary and metastatic neoplasms | *Primary and metastatic neoplasms | ||
*Wegener's, sarcoidosis | *Wegener's, sarcoidosis | ||
==Clinical Presentation== | |||
*Several weeks of cough, fever, pleuritic chest pain, wt loss, night sweats | |||
**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 | |||
==Diagnosis== | ==Diagnosis== | ||
*CXR | *CXR | ||
*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 communicatio nof abscess cavity w/ a bronchiole | **Air-fluid level indicates communicatio nof abscess cavity w/ a bronchiole | ||
==Treatment== | ==Treatment== | ||
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==See Also== | ==See Also== | ||
[[Empyema]] | *[[Empyema]] | ||
==Source== | ==Source== | ||
Revision as of 07:13, 1 May 2015
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
Clinical Presentation
- Several weeks of cough, fever, pleuritic chest pain, wt loss, night sweats
- 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
Diagnosis
- 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
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