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1 lung abscess(lh)
 

1 lung abscess(lh)

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    1 lung abscess(lh) 1 lung abscess(lh) Presentation Transcript

    • PULMONARY ABSCESS Huai Liao Pulmonary department, the 1 st affiliated hospital of Sun Yat-sen university
    • Backgrounds
      • A necrotizing parenchymal lung infection generally caused by aspiration
      • Clincal fectures: high fever, sputum
      • Radiograph: cavity>2cm
      • Mobidity: male>female
      • Incidence:↓
    •  
    • Etiology
      • Organisms: the flora of upper respiratory tract, ~ 90% anaerobic
      • Out of hospital: anaerobes colonized the mouth, pneumococci, staphylococci, enteric gram negatives (in elderly)
      • In hospital: both anaerobes and aerobes, usually S aureus and enteric gram negative bacilli
    • Categories
      • Aspiratory lung abscess
      • Secondary lung abscess
      • Hematogenous lung abscess
    • Aspiratory lung abscess
      • Predisposing Conditions
        • Unconscious state
        • Aspiration of a Large Bacterial Inoculums
        • Loss of Cough Refle
    • Common Segments
      • Gravitational forces and position of the patient determine the site
      • 1) sitting position –RLL
      • 2) supine position –RLL
      • 3) right lateral decubitus position --RUL
    • Bacteriology
      • Common pathogens
      • 1) gram positive anaerobes -- peptococci and peptostreptococci
      • 2) gram negative anaerobes
    • Secondary abscess
      • Secondary to preexisting conditions
      • Bronchial cysts, carcinoma, TB cavity
      • Food and foreign body
      • The lesion of adjacent organ
        • Subphrenic abscess
        • Perinephric abscess
        • Amebic as abscess of the liver
    • Secondary abscess
    • Hematogenous lung abscess
      • Extrapulmonary infections
      • Via bloodstream
      • Radiograph
      • Pathogen: staphylococcus aureus, stapphylococcus epidermidis, or streptococcus
    • Hematogenous lung abscess
      • Common Segment--multiple,in fringe of lung
      • Common pathogens--staphylococcus aureus
    • Pathology
      • The abscess is characterized by destruction of lung tissue forming a cavity
      • The cavity is filled with pus (necrotic debris/liquid) or pus and gas (air)
      • The abscess(s) may occur in any part of the lung
    • Pathology ( Early)
      • begin as local infections
    • Pathology ( Later)
      • suppuration and necrosis
      • Cavity with fluid level forms
    • Pathology ( Later)
      • Pyopneumothorax or empyema
      • Chronic lung abscess
      • Angioma: haemoptysis
    • Clinical Picture
      • Acute onset
      • High fever, chills, productive cough with sputum, chest pain, anorexia, malaise,
      • Coughing up a large amount of pus
      • Haemoptysis (1/3)
      • Pleuritic pain, dyspnea
      • Chronic abscess: persistent symptoms, Weight loss and anemia
      • Hermatogenous abscess: primary infection, pyemia, followed by a cough, rarely haemoptysis
    • Clinical Picture
      • Physical finding
      • Early phases: those of pneumonia, with or without a pleural effusion
      • Later stage: amphoric or cavernous breath sounds, pleural effusions, empyema
    • Laboratory examination
      • Blood Rt: WBC↑ , N%↑; anemia
      • Sputum Gram Stain
      • Bacterial cultures:
      • Bronchoscopy
      • Fine Needle Aspiration
      • Bronchoscopy:
      • Diagnosis
      • Specimen Collection
      • Drainage of Pus
    • Laboratory examination
      • Chest radiograph
      • --a parenchymal infiltrate with a cavity containing an air-fluid level
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    • Bronchoscopy
      • Diagnostic value:
      • Exclude carcinoma and foreign body
      • Collect specimen
      • Therapeutic value
    • Diagnosis
      • Symptoms, sign, and Roentgenographic finding
      • differentiate from:
      • 1)pneumonia
      • 2)lung cancer
      • 3)pulmonary tuberculosis
      • 4)infected cyst
    •  
    • Differential diagnosis
      • Pneumonia
        • Chest X-ray: infiltration without cavity
        • Short course
      • Pulmonary TB
        • Sputum smear for TB bacilli
        • bronchoscopy
    • Differential diagnosis
      • Bronchial carcinoma
        • Obstructive pneumonia
        • Cavitated bronchial carcinoma
      • Infected lung cyst
        • Chest X-ray: thin walled, prior radiograph
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    • Treatment
      • Antibiotic
      • 1.Antibiotic of Choice :
      • 1) Penicillin
      • 2) Metronidazole
      • 3) Clindamycin
      • 4) Others
      • 2.The expected response:
      • decrease fever within 3~7d, elimination of fever within 7~14d, resolves the putrid odor of the sputum within 3~10d.
      • 3.Prolonged treatment 8~12 weeks
    • Treatment
      • Methods of Drainage
      • 1) Postural Drainage
      • 2) Percussion on back
      • 3) Bronchoscopy
      • Role of Surgery
        • Chonic abscess
        • Massive haemoptysis
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    • Prevention
      • Risk factors
      • Early treatment
      • Adequate course
    • Thank you!