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Lung abscessFrom Wikipedia, the free encyclopedia

Jump to: navigation , search Lung abscess

Classification and external resources

Computed tomography (CT) scan of chest showing bilateral

pneumonia with abscesses, effusions, and caverns. 37 year

old male.

ICD - 10 J85.

ICD - 9 513.0

Di seases DB 7607

eMed icine med/1332

MeSH D008169


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Lung abscess is necrosis of the pulmonary tissue and formation of cavities (more than 2 cm) [1] containing necrotic debris or fluid caused by microbial infection.

This pus-filled cavity is often caused by aspiration, which may occur during alteredconsciousness. Alcoholism is the most common condition predisposing to lung abscesses.

Lung abscess is considered pr im ary (60% [2]) when it results from existing lung parenchymal process and is termed secondary when it complicates another process e.g. vascular emboli or follows rupture of extrapulmonary abscess into lung.

C ontents

[hide ]

y 1 Causes y 2 Signs and symptoms y 3 Diagnosis y 4 Management y 5 Complications y 6 Prognosis y 7 See also y 8 References

[ed i t ] C auses

Conditions contributing to lung abscess

y Aspiration of oropharyngeal or gastric secretiony Septic emboliy N ecrotizing pneumonia y V asculitis : Wegener's granulomatosis y N ecrotizing tumors : 8% to 18% are due to neoplasms across all age groups, higher in

older people; primary squamous carcinoma of the lung is the commonest.

Organisms

In the post-antibiotic era pattern of frequency is changing. In older studies anaerobes were foundin up to 90% cases but they are much less frequent now [3].

y Anaerobic bacteria : Peptostreptococcus , Bacteroides , Fusobacterium species,y Microaerophilic streptococcus : S treptococcus milleri y Aerobic bacteria : Staphylococcus , Klebsiella , Haemophilus , Pseudomonas , N ocardia ,

Escherichia coli , Streptococcus , Mycobacteria [4 ] y Fungi : Candida , Aspergillus


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y Parasites: Entamoeba histolytica ,

[ed i t ] S igns and sy m pto m s

Onset of symptoms is often gradual, but in necrotizing staphylococcal or gram-negative bacillary pneumonias patients can be acutely ill. Cough , fever with shivering and night sweats are often present. Cough can be productive with foul smelling purulent sputum (70%) or less frequentlywith blood (i.e. hemoptysis in one third cases) [5]. Affected individuals may also complain of chest pain, shortness of breath, lethargy and other features of chronic illness.

Patients are generally cachectic at presentation. Finger clubbing is present in one third of patients [5]. Dental decay is common especially in alcoholics and children. On examination of chest there will be features of consolidation such as localised dullness on percussion , bronchial

breath sound etc.

[edit ]

Diagnos

is

Pathology image of a lung abscess.Chest Xray and other imaging studies

Abscess is often unilateral and single involving posterior segments of the upper lobes and theapical segments of the lower lobes as these areas are gravity dependent when lying down.Presence of air-fluid levels implies rupture into the bronchial tree or rarely growth of gasforming organism.

Laboratory studies

Raised inflammatory markers (high ESR , CRP ) are usual but not specific. Examination of

sputum is important in any pulmonary infections and here often reveals mixed flora.Transtracheal of Transbronchial (via bronchoscopy) aspirates can also be cultured. Fibre optic bronchoscopy is often performed to exclude obstructive lesion; it also helps in bronchialdrainage of pus.

[ed i t ] Manage m ent


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Broadspectrum antibiotic to cover mixed flora is the mainstay of treatment. Pulmonary physiotherapy and postural drainage are also important. Surgical procedures are required inselective patients for drainage or pulmonary resection.

[ed i t ] C om pl icat ions

Rare nowadays but include spread of infection to other lung segments, bronchiectasis , empyema ,and bacteraemia with metastatic infection such as brain abscess [2].

[ed i t ] Prognos is

Most cases respond to antibiotic and prognosis is usually excellent unless there is a debilitatingunderlying condition. Mortality from lung abscess alone is around 5% and is improving.

[ed i t ] See alsoy Other chronic lung infections

o Empyema o Bronchiectasis

y Abscess y Pleural effusion

[ed i t ] References

1. ^ Bartlett JG, Finegold SM (1972). "Anaerobic pleuropulmonary infections". M edicine

(Baltimore) 51

(6):4

1350. PMID 4

5644

16.2. ^ a b "Pneumonia and Other Pulmonary Infections: Lung Abscess, Medscape" . Archivedfrom the original on 2007-10-11.http://web.archive.org/web/20071011102817/http://www.medscape.com/viewarticle/53 4860 . Retrieved 2007-06-20.

3. ^ Bartlett JG (2005). "The role of anaerobic bacteria in lung abscess". Clin. Infect. Dis. 40 (7): 9235. doi:10.1086/ 4 28586 . PMID 1582 4 980 .

4 . ^ Hirshberg B, Sklair-Levi M, N ir-Paz R, Ben-Sira L, Krivoruk V , Kramer MR (1999)."Factors predicting mortality of patients with lung abscess.". Chest 11 5 (3): 7 4 650.doi :10.1378/chest.115.3.7 4 6. PMID 1008 44 87.

5. ^ a b Moreira Jda S, Camargo Jde J, Felicetti JC, Goldenfun PR, Moreira AL, Porto N da S

(2006). "Lung abscess: analysis of 252 consecutive cases diagnosed between 1968 and200 4 ". J ornal brasileiro de pneumologia : publicaa

o oficial da S ociedade Brasileira de Pneumologia e Tisilogia 32 (2): 136


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