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MR .OM VERMA
 Localized suppurative inflammation of the
lung.
 Necrosis of the pulmonary tissue & formation of
cavities containing necrotic debris or fluid caused
by microbial infection.
 A localized area of destruction of lung parenchyma in
which infection by pyogenic organisms results in tissue
necrosis & suppuration .
 It manifests radio graphically as a cavity with an air –
fluid levels.
 Lung Abscess is a localized necrotic lesion of
the lung parenchyma containing purulent
material that collapses and forms a cavity. It is
generally caused by aspiration of anaerobic
bacteria.
Lung abscess
Inhalation
lung abscess
Pneumonic
abscess
Embolic
abscesses
Location:
 Dependent areas (posterior segments of upper & lower lobes).
Stages:
 Pneumonic stage: patch of consolidation.
 Rupture: central necrosis, communication with a bronchus & expec-
toration of the liquid centre.
 Acute cavitations: irregular thick wall, shaggy ( khurdura) inner margin &
surrounding consolidation (collection).
 Chronic cavitation: thin wall, smooth inner margin & subsidence of
surrounding inflammatory reaction.
Complication of pneumonia:
 Staph pneumonia.
 Klebsiella pneumonia.
 T.B.
Lung abscess
with bulging
fissure ( a long
narrow
opening or line
of breakage )
sign.
EMBOLIC
ABSCESSES
 an abscess arising distal to the point of arrest of a
septic embolus.
 A septic embolism is a type of embolism that is
infected with bacteria, resulting in the formation of
pus. a clot or other plug, usually part or all of a 
THROMBUS
 Infected catheters.
 Infected pacemakers.
 Tricuspid endocarditic ( IV drug abusers).
 ETOLOGY
 Hematogenous ( originating in the blood. 2.
producing blood or components of blood. 3.
distributed orspread by way of the bloodstream, as
in metastases of tumors or in infections; blood-borne.
spread from a distal site)
• UTI
• Abdominal sepsis
• Pelvic sepsis
• Infective endocarditic
• IV drug abuse
• Infected IV cannulae
• Septic thrombophlebitis = venous thrombosis,
inflammation, and bacteremia. 
• Bronchiectasis
• Cystic fibrosis
• Bronchial obstruction : tumour, foreign body,
cong.abn
 Infected pulmonary infarct
 Trauma
 Immunodeficiency = immunodeficiency disease
characterized by eczema, recurrent staphylococcal
skin abscesses, recurrent lung infections,
eosinophilia (a high number of eosinophils in the
blood) and high serum levels of IgE.
 Lung Abscess  pyogenic lung
infection/pneumonia, necrotizing pneumonia. ...
The most frequent cause is aspiration of
anaerobic organisms from the mouth in those
predisposed to ... Penetrating
pulmonary trauma - eg, a stab wound.
 Tuberculosis & non tuberculous mycobacterial infection
– fluid filled cavities – upper lobes / apical segments of
lower lobes
 Fungal infection – Histoplasma capsulatum
Blastomyces dermatitidis
Coccidiodes immitis
Aspergillus
Cryptococcus neoformans
Candida
 Aspiration of oropharyngeal or gastric secretion.
 2) Septic emboli.
 Necrotizing pneumonia
 Necrotizing tumors
 Gram negative organisms. (klebsiella)
 Anaerobic bacilli (Bacterorides
 Carcinoma of the lung
 Parasitic and fungal diseases of the lung.
 TB
 Lung abscess starts as an area of pneumonia
 Small zones of necrosis
 Coalesce together to from one or more large
cavities of 1-2 c.m
 Progressive and enlargement to from the abscess
cavity
 The abscess cavity well erode( increase) a
bronchus
 Expec-toration of purulent sputum with air fluid
formation in the cavity
 Fate
 1. infection of the other lung
 2. Open into pleura –pyopneumothorax
 3. Hematogenous spread
 The presenting features of lung abscess vary
considerably .
1. Symptoms progress over weeks to
months
2. Fever, cough, and sputum production
3. Night sweats, weight loss & anemia
4. Hemoptysis,  is the coughing up of blood or
blood-stained mucus from the bronchi, larynx,
trachea, or lungs. 
 Digital clubbing – develop within a few weeks if
treatment is inadequate.
 Dullness to percussion
 Diminished breath sounds if abscess is too large
and situated near the surface of lung.
 Amphoric / cavernous breath sounds
 Cough with foul smelling purulent sputum.
 Fever with shivering
 Night sweats
 Chest pain
 Shortness of breath
 Lethargy
 ) Finger clubbing
 Leukocytosis  refers to an increase in the total number
of WBCs
 Anorexia
 Weight loss
 Weakness
 Dyspnea
Lung abscess
Acute
< 6 weeks.
Chronic
> 6 weeks
 CT SCAN = thick-walled, usually round cavity
with irregular margins forming an acute angle with
chest wall, no signs of compression of surrounding
lung .
 Bronchoscopy
 proximal airway obstruction by a tumour or foreign
body
 LUNGS XRY
 Chest x-rays nearly Identifying the lung
abscess as a cavity filled with fluid and air.
 Sputum Gram Stain: 
May occasionally be helpful if there is a large
number of white blood cells and bacteria
consistent with oropharyngeal flora.
-
X RY
Irregularly sharp cavity with an air-fluid level inside
Chest physiotherapy and postural
drainage
and postural drainage may improve clearance of
the purulent and necrotic abscess contents
  
 Arterial Blood Gas Test
 The arterial blood gas  
 test is a test used to check the level of
oxygen and carbon dioxide in your blood. A
doctor or nurse will take blood from the
artery in your wrist. Then, they will send the
blood to a lab for testing. The results of this
test indicate the amount of oxygen and
carbon dioxide in your blood.
 Pulse Oximetry Test
 The doctor will measure your oxygen level using a
small sensor that’s placed on the tip of your finger
to see if you are getting enough oxygen. This is
called the pulse oximetry test 
 Physical Examination
 During a physical exam, your doctor will listen
for abnormal sounds in your lungs and heart using
a stethoscope.
1 Amoxicillin x orally
1. Metronidazole 400mg TDS –Anaerobes
2. Cry.penicillin & clindamycin +/- metronidazole
IV – in hospitalised pts.
3. Can change – according to sensitivity
 COMPLICATION
 Caused by spread of infection into the pleural
space or by contamination of the pleural cavity
after percutaneous drainage.
 Amyloidosis 
 is a group of diseases in which abnormal protein,
known as amyloid fibrils, builds up in tissue. 
 Hemoptysis is the coughing up of blood or
blood-stained mucus from the bronchi, larynx,
trachea, or lungs. 
Lung abscess

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Lung abscess

  • 2.  Localized suppurative inflammation of the lung.  Necrosis of the pulmonary tissue & formation of cavities containing necrotic debris or fluid caused by microbial infection.  A localized area of destruction of lung parenchyma in which infection by pyogenic organisms results in tissue necrosis & suppuration .  It manifests radio graphically as a cavity with an air – fluid levels.
  • 3.  Lung Abscess is a localized necrotic lesion of the lung parenchyma containing purulent material that collapses and forms a cavity. It is generally caused by aspiration of anaerobic bacteria.
  • 5. Location:  Dependent areas (posterior segments of upper & lower lobes). Stages:  Pneumonic stage: patch of consolidation.  Rupture: central necrosis, communication with a bronchus & expec- toration of the liquid centre.  Acute cavitations: irregular thick wall, shaggy ( khurdura) inner margin & surrounding consolidation (collection).  Chronic cavitation: thin wall, smooth inner margin & subsidence of surrounding inflammatory reaction.
  • 6. Complication of pneumonia:  Staph pneumonia.  Klebsiella pneumonia.  T.B.
  • 7. Lung abscess with bulging fissure ( a long narrow opening or line of breakage ) sign.
  • 8. EMBOLIC ABSCESSES  an abscess arising distal to the point of arrest of a septic embolus.  A septic embolism is a type of embolism that is infected with bacteria, resulting in the formation of pus. a clot or other plug, usually part or all of a  THROMBUS
  • 9.
  • 10.  Infected catheters.  Infected pacemakers.  Tricuspid endocarditic ( IV drug abusers).
  • 12.  Hematogenous ( originating in the blood. 2. producing blood or components of blood. 3. distributed orspread by way of the bloodstream, as in metastases of tumors or in infections; blood-borne. spread from a distal site) • UTI • Abdominal sepsis • Pelvic sepsis • Infective endocarditic • IV drug abuse • Infected IV cannulae • Septic thrombophlebitis = venous thrombosis, inflammation, and bacteremia. 
  • 13. • Bronchiectasis • Cystic fibrosis • Bronchial obstruction : tumour, foreign body, cong.abn  Infected pulmonary infarct  Trauma  Immunodeficiency = immunodeficiency disease characterized by eczema, recurrent staphylococcal skin abscesses, recurrent lung infections, eosinophilia (a high number of eosinophils in the blood) and high serum levels of IgE.
  • 14.  Lung Abscess  pyogenic lung infection/pneumonia, necrotizing pneumonia. ... The most frequent cause is aspiration of anaerobic organisms from the mouth in those predisposed to ... Penetrating pulmonary trauma - eg, a stab wound.
  • 15.  Tuberculosis & non tuberculous mycobacterial infection – fluid filled cavities – upper lobes / apical segments of lower lobes  Fungal infection – Histoplasma capsulatum Blastomyces dermatitidis Coccidiodes immitis Aspergillus Cryptococcus neoformans Candida
  • 16.  Aspiration of oropharyngeal or gastric secretion.  2) Septic emboli.  Necrotizing pneumonia  Necrotizing tumors  Gram negative organisms. (klebsiella)  Anaerobic bacilli (Bacterorides  Carcinoma of the lung  Parasitic and fungal diseases of the lung.  TB
  • 17.  Lung abscess starts as an area of pneumonia  Small zones of necrosis  Coalesce together to from one or more large cavities of 1-2 c.m  Progressive and enlargement to from the abscess cavity  The abscess cavity well erode( increase) a bronchus
  • 18.  Expec-toration of purulent sputum with air fluid formation in the cavity  Fate  1. infection of the other lung  2. Open into pleura –pyopneumothorax  3. Hematogenous spread
  • 19.  The presenting features of lung abscess vary considerably . 1. Symptoms progress over weeks to months 2. Fever, cough, and sputum production 3. Night sweats, weight loss & anemia 4. Hemoptysis,  is the coughing up of blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs. 
  • 20.  Digital clubbing – develop within a few weeks if treatment is inadequate.  Dullness to percussion  Diminished breath sounds if abscess is too large and situated near the surface of lung.  Amphoric / cavernous breath sounds  Cough with foul smelling purulent sputum.  Fever with shivering  Night sweats  Chest pain  Shortness of breath  Lethargy  ) Finger clubbing
  • 21.  Leukocytosis  refers to an increase in the total number of WBCs  Anorexia  Weight loss  Weakness  Dyspnea
  • 22. Lung abscess Acute < 6 weeks. Chronic > 6 weeks
  • 23.  CT SCAN = thick-walled, usually round cavity with irregular margins forming an acute angle with chest wall, no signs of compression of surrounding lung .  Bronchoscopy  proximal airway obstruction by a tumour or foreign body  LUNGS XRY  Chest x-rays nearly Identifying the lung abscess as a cavity filled with fluid and air.
  • 24.  Sputum Gram Stain:  May occasionally be helpful if there is a large number of white blood cells and bacteria consistent with oropharyngeal flora. - X RY Irregularly sharp cavity with an air-fluid level inside Chest physiotherapy and postural drainage and postural drainage may improve clearance of the purulent and necrotic abscess contents
  • 25.     Arterial Blood Gas Test  The arterial blood gas    test is a test used to check the level of oxygen and carbon dioxide in your blood. A doctor or nurse will take blood from the artery in your wrist. Then, they will send the blood to a lab for testing. The results of this test indicate the amount of oxygen and carbon dioxide in your blood.
  • 26.  Pulse Oximetry Test  The doctor will measure your oxygen level using a small sensor that’s placed on the tip of your finger to see if you are getting enough oxygen. This is called the pulse oximetry test   Physical Examination  During a physical exam, your doctor will listen for abnormal sounds in your lungs and heart using a stethoscope.
  • 27. 1 Amoxicillin x orally 1. Metronidazole 400mg TDS –Anaerobes 2. Cry.penicillin & clindamycin +/- metronidazole IV – in hospitalised pts. 3. Can change – according to sensitivity
  • 29.  Caused by spread of infection into the pleural space or by contamination of the pleural cavity after percutaneous drainage.  Amyloidosis   is a group of diseases in which abnormal protein, known as amyloid fibrils, builds up in tissue.   Hemoptysis is the coughing up of blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs.