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lung abscess
Lung abscess is a type of liquefactive necrosis and formation of cavities greater than 2cm in the lung tissue caused by microbial infection. It is often caused by aspiration during anesthesia, sedation, or unconsciousness. Risk factors include age, male sex, and conditions like periodontal disease or dysphagia. Symptoms include cough with foul sputum, chest pain, fever, and weight loss. Diagnosis involves imaging like x-ray or CT scan showing spherical areas of density and air-fluid levels. Treatment is generally broad spectrum antibiotics for 6-8 weeks along with drainage procedures in some cases.
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lung abscess
- 1. Topic:- lung absecess presentedby:- dr. shameer basha,
- 2. Lung abscess s/no topicpage no intradution to lung abscess definition classification risk factors causes pathpysiology signs & symptoms diagnosis physical examination instrumental findings laboratory findings differentioal diagnosis complications treatment references index
- 3. Lung abscess:- is atype of liquefactive necrosis of the lung tissue and formation of cavities (more than 2 cm)containing necrotic debris or fluid caused by microbial infection. This pus-filled cavity is often caused by aspiration, which may occur during anesthesia, sedation, or unconsciousness from injury. Alcoholism is the most common condition predisposing to lung abscesses. Classification:- Lung abscesses can be classified based on the duration & the likely etiology a)Acute abscess:- A lung abscess is defined as acute if the patient presents with symptoms of <2weeks duration. Patients with an acute lung abscess are less likely to have an underlying neoplasm, but are more likely to have an infection caused by a virulent aerobic bacterial agent. b)Chronic abscess:- A chronic lung abscess is defined by symptoms lasting for>4-6weeks. Patients more like to have an underlying neoplasm or infection with a less virulent anaerobic agent. 1)Primary abscesses :- are caused by an infection, pneumonia, within our lung. Aspiration pneumonia is an infection that develops after food or secretions from your mouth, stomach, or sinuses are inhaled into
- 4. your lungs insteadof going into your esophagus. It’s a very common cause of primary abscesses. Secondary abscesses:- are caused by anything other than an infection that starts in our lung. This can be an obstruction of the large airways in our lung, coexisting disease in our lungs, or infections from other parts of our body that spread to our lungs. Risk factors:- Age:- Lung abscesses likely to occur more commonly in elderly patients because of Increased incidence of periodontal disease,Increased prevalence of dysphagia. Sex:- A male predominance is reported in published case series. Causes:- Aspiration of oropharyngeal or gastric secretion Septic emboli Necrotizing pneumonia Vasculitis: Granulomatosis with polyangiitis Aerobic bacteria:- Actinomyces,peptostreptococcus,bacteroides,fusobacterium species,streptococcus miller. Aerobic bacteria:- Staphylococcus, Klebsiella, Haemophilus, Pseudomonas, Nocardi, Escherichia coli, Streptococcus, Mycobacteria. Fungi:- Candida,asperagillus
- 5. Pathphysiology:- Lung abscesses beginas areas of pneumonia in which small zones of necrosis (or microabscesses) develop within the consolidated lung. Some of these areas coalesce to form single or sometimes multiple areas of suppuration that, when they reach an arbitrary size of 1-2 cm in diameter, are customarily referred to as abscesses. If natural history of this pathological process is interrupted at an early stage by appropriate antimicrobial treatment, then healing may be complete with no residual radiographic evidence ofdamage. Signs & symptoms:-
- 6. Patients present withSeverecough with Profuse foul smelling sputum, may be foetid. There may be large amounts of purulent sputum once a bronchial communication has been established Putrid sputum is a highly specific symptoms that is pathognomonic for anaerobic infection. although present in only 50—60%of patients Haemoptysis (25%of patients) – not uncommon and may be life- threatening. Chest pain (pleuritic or deep-seated aching discomfort)60% of patients Fever – usually high with chill & rigor, profuse night sweating Constitutional upset like- malaise, weakness Weight loss (60%of patients) – with an average loss of between 15 &20 lbs Anorexia Symptoms of associated disease process eg-Bronchial obstruction due to lung cancer Oesophageal obstruction due to achalasia Right-sided endocarditis Dyspnoea Diagnosis:- Physical examination:- o There is no signs specific for lung abscess o Patient is toxic with high temperature & Halitosis o Clubbing may develop within few weeks if treatmentis inadequat On chest exam:-
- 7. o Evidence ofconsolidation o Dullness to “percussion” and diminished breath sounds, if the abscess is large and situated near the surface of the lung. o The ‘amorphic’ or ‘cavernous’ breath sound during “ausscultation”. Imaging studies Lung abscesses are often on one side and single involving posterior segments of the upper lobes and the apical segments of the lower lobes as these areas are gravity dependent when lying down. x-ray:- Radiographic abnormality may start with a pneumonic infiltrate followed by the development of one or more spherical areas of more homogeneous density in which air-fluid levels often arise indicating the formation of a bronchial communication.
- 8. Presence of air-fluidlevels implies rupture into the bronchial tree or rarely growth of gas forming organism.
- 9. Pulmonary abscess onCXR CT scan:- the thorax right upper lobe shows a thick-walled cavity.
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- 11. Pathology image ofa lung abscess. Laboratory studies:- Raised inflammatory markers (high ESR, CRP) are common but nonspecific. Examination of the coughed up mucus is important in any lung infection and often reveals mixed bacterial flora. Transtracheal or transbronchial (via bronchoscopy) aspirates can also be cultured. Fiber optic bronchoscopy is often performed to exclude obstructive lesion; it also helps in bronchial drainage of pus. Sputum examination:-
- 12. o Gram staining& C/S (both aerobic & anaerobic) o Repeated isolation of a predominant organism suggests that this may be a true pathogen o cytology for malignant cell o Stain and culture for Fungus Charecterstics of sputum:- If the sputum is kept in a bottle, there are 3 layers Upper – Frothy Middle – thick liquid Lower – sediment (epithelial debris, bacteria) Diffrentioal diagnosis:- o Consolidation (during resolution stage), usually no clubbing o Bronchiectasis o Bronchial carcinoma, usually Squamous cell carcinoma o Pulmonary tuberculosis (without causing abscess) o Rare infections, including – Actinomycosis, Nocardiasis, Fungal pneumonia o Lung cancer and lung abscess o Empyema Complications:- o Pleurisy o Massive haemoptysis o Spontaneous rupture into uninvolved lung segments o Failure of abscess cavity to resolve o Empyema -Rupture into pleural space causing empyema
- 13. o Bronchiectasis o Pleuralfibrosis o Trapped lung Results from a bronchopleural fistula. Treatment:- Broad spectrum antibiotic. Amoxiccilin 500mg each 7hours daily 7weeks Clindamycin + fluoroquinolone 3 times daily 7 weeks to cover mixed flora is the mainstay of treatment. Pulmonary physiotherapy and postural drainage are also important. Surgical procedures are required in selective patients for drainage or pulmonary resection. the treatment is divided according to the type of abscess acute or chronic if it's acute the treatment is a- antibiotics: if anaerobic -> metronidazole or clindamycin if aerobic-> B-lactams, cephalosporins if MRSA or Staph infection vancomycin or linezolide b- postural drainage and chest physiotherapy . bronchoscopy: is used for the following cases: 1-aspiration or instillation of antibiotics 2- patients with atypical presentation suspected of having underlying foreign body or malignancy. References:- https://en.wikipedia.org/wiki/Lung_absce
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