1 lung abscess(lh)

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1 lung abscess(lh)

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

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