LUNG ABSCESS

SIFO ABRAHAM

OUTLINE DEFINITION

CLASSIFICATIONS

PATHOPHYSIOLOGY

SYMPTOMS

PHYSICAL FINDINGS

FACTORS CONTRIBUTING TO LUNG ABSCESS

DIFFERENTIAL DIAGNOSIS

WORKUP

TREATMENT

DEFINITION Necrosis of pulmonary tissues and

formation of necrotic debris containing necrotic debris caused by microbial infection.

The formation of multiple small abscesses <2cm is occasionally referred to as necrotizing pneumonia or lung gangrene.

CLASSIFICATION Lung abscess is classified based on its

duration or etiology.

Acute abscess occuring less than 4-6weeks

Chronic abscess longer duration

Primary abscess caused by aspiration or pneumonia

Secondary abscess caused by obstruction, bronchietasis, immuno-compromised state

pathophysiology Lung abscess is a

complication of aspiration pneumonia caused by mouth anaerobes.

Also caused by septic emboli to the lungs caused by

1.Bacteremia

2.Tricuspid valve endocarditis

Anaerobes causing lung abscess

Peptostreptococcus spp.

Bacteroides spp.

Fusobacterium spp.

Microaerophilic streptococci

symptoms The usual symptoms include fever

cough with sputum production

anorexia

weight loss

night sweats.

Hemoptysis and pleurisy

Physical findings Patients presents with low-grade fever in

anaerobic infections & temperature greater than 38.5C in other infections.

Evidence of gingival disease.

Clinical findings of consolidations:{decreased breath sounds, dullness to percussion, bronchial breath sound, course inspiratory crackles

Factors Oral cavity disease

Periodontal disease

Gingivitis

Inability to protect airways

Alcoholism

Coma

Drug abuse

Immunocompromised

Steroid chemotherapy

Malnutrition

Multiple trauma

Esophageal disease

Achalasia

Reflux disease

Esophageal obstruction

Bronchial obstruction

Tumor

Foreign bdy

stricture

DIFFERENTIAL DIAGNOSIS

Alcoholism

Empyema, Pleuropulmonary

Hydatid Cysts

Infective Endocarditis

Lung Cancer, Non-Small Cell

Lung Cancer, Oat Cell (Small Cell)

Pneumonia, Bacterial

Pneumonia, Fungal

Pulmonary Embolism

Sarcoidosis

Thrombophlebitis, Septic

Tuberculosis

Wegener Granulomatosis

WORKUPlab studies

CBC

Obtain sputum for gram stain, culture and sensitivity

Blood culture

Sputum for ova and parasite

Imaging studies CXR

A typical chest radiographic appearance of a lung abscess is an irregularly shaped cavity with an air-fluid level inside. Lung abscesses as a result of aspiration most frequently occur in the posterior segments of the upper lobes or the superior segments of the lower lobes.

Pneumococcal pneumonia complicated by lung necrosis and abscess formation.

CT scan CT scanning of the lungs may help visualize

the anatomy better than chest radiography. CT scanning is very useful in the identification of concomitant empyema or lung infarction.

TREATMENTantibiotic therapy

Clindamycin: an effective drug over penicillin because several drugs produce beta lactamase thereby showing drug resistance

Metronidazole: an effective drug with a failure rate of 50%

SURGICAL CARE Surgery is very rarely required for patients

with uncomplicated lung abscesses. The usual indications for surgery are failure to respond to medical management, suspected neoplasm, or congenital lung malformation. The surgical procedure performed is either lobectomy or pneumonectomy.

REFERENCES http://emedicine.medscape.com/article/2994

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http://www.healthline.com/health/lung-abscess#Overview

http://www.patient.co.uk/doctor/lung-abscess