Lung abscess


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Lung abscess

  1. 1. Lung abscess Dr / Hytham Nafady
  2. 2. Definition• Localized suppurative inflammation of the lung.
  3. 3. Types of lung abscess Lung abscess Inhalation Pneumonic Emboliclung abscess abscess abscesses
  4. 4. Inhalation lung abscessLocation:• Dependent areas (posterior segments of upper & lower lobes).Stages:• Pneumonic stage: patch of consolidation.• Rupture: central necrosis, communication with a bronchus & expectoration of the liquid centre.• Acute cavitation: irregular thick wall, shaggy inner margin & surrounding consolidation.• Chronic cavitation: thin wall, smooth inner margin & subsidence of surrounding inflammatory reaction.
  5. 5. Pneumonic abscessComplication of pneumonia:• Staph pneumonia.• Klebsiella pneumonia.• T.B.
  6. 6. Necrotizing klebsiella pneumonia Lung abscess with bulging fissure sign.
  7. 7. Embolic abscesses 1ry 2ry Due to impaction Due to infection of septic embolus of infarcted lungin pulmonary artery
  8. 8. Source of septic emboli• Infected catheters.• Infected pacemakers.• Septic thrombophlebitis of the IJV (Lemierres syndrome).• Tricuspid endocarditis ( IV drug abusers).
  9. 9. Lemierre’s syndrome
  10. 10. Lemierre’s syndrome
  11. 11. Clinical Lung abscess Acute Chronic< 6 weeks. > 6 weeks
  12. 12. C.P• Cough & expectoration of purulent sputum.• Constitutional symptoms.
  13. 13. Radiological findings of abscess• Rounded cavity with air fluid level & surrounding consolidation.• Appear rounded in frontal & lateral projections (DD with empyema).• All margins can be equally seen (DD with empyema).
  14. 14. CT• Cavitary lesion with or without air fluid level.• Thick irregular wall (acute).• Thin smooth wall (chronic).• Surrounding consolidation.• Truncation of the bronchi & vessels at the wall of the abscess.
  15. 15. DD of lung abscessCavitary Hiatal Empyema lesion hernia
  16. 16. DD of cavitary lung lesions CAVITY• Carcinoma. Squamous cell carcinoma, lymphoma & metastsis.• Autoimmune:(Wegner granulomatosis & Rheumatoid nodule).• Vascular: emboli (septic or bland)• Infection: (bacteria, fungal or ameobic).• Trauma: lung laceration.• Young (congenital): sequsetrated lung segment, CCAM & bronchogenic cyst.
  17. 17. Cavitary lesions Infective Neoplastic Autoimmune Rheumatoid Bacteria Fungal Parasitic 1ry 2ry WG nodules Amoebic Bronchogenic Staph Aspergillosis lung abscess CarcinomaKlebsiella Histoplasmosis Lymphoma TB
  18. 18. Thick walled cavity (>3 mm) Acute Neoplastic Auto-immuneabscess Wegner’s Rheumatoid 1ry 2ry graulomatosis nodules
  19. 19. Multiple cavities Benign Malignant Cysticbronchiectasis Metastases Septic Emboli Lymphoma Rheumatoid Nodules Wegnergranulomatosis
  20. 20. Cavitary lesions Contents Air fluid level Air only Intracavitary soft tissue density Surface of Wall thickness the fluid level Fungal ball (most common) Rupture hydatid cystStraight Wavy Thick Thin Breakdown in a tumour Acute ruptured Blood clotAbscess hydatid cyst Irregular Site Tumor breakdown Central in the lung Peripheral subpleural Regular emphysematous Pneumatocele Chronic abscess bulla
  21. 21. Cavitary lesions by location Upper Lower lung zones lung zones TB Aspiration Lung abscess AmoebicHistoplasmosis Lung abscess (Rt) Pulmonary infarction Sequestrated lung segment (Lt)
  22. 22. Cavitary bronchogenic carcinoma
  23. 23. Lung contusion & laceration
  24. 24. Wegner’s granulomatosis
  25. 25. Infected Intralobar pulmonary sequestration Antibiotics
  26. 26. Infected CCAM
  27. 27. Empyema
  28. 28. Hiatal hernia
  29. 29. Hydatid cyst
  30. 30. Empyema Vs lung abscess• Differntiation between lung abscess & empyema is essential because of different treatment strategies.
  31. 31. TTT of Lung abscess TTT of EmpyemaAntibiotics & postural Percutaneous drainagedrainage
  32. 32. Abscess EmpyemaX-ray Rounded in all Lentiform. projections.CT Split pleura sign (separation of thickened visceral & parietal pleura).Wall Acute abscess has Smooth wall. thick irregular wall.Angle with Acute angle Obtuse anglethe pleura Surrounding Compression of consolidation adjacent lung