Lung abscesses can be classified based on duration, etiology, pathogen, and location. Acute abscesses present within 2 weeks and are usually caused by virulent bacteria like S. aureus, while chronic abscesses last over 4-6 weeks and may be caused by tumors or less virulent anaerobes. Lung abscesses are most commonly caused by aspiration of infected materials or inadequately treated pneumonia. Common pathogens include anaerobic bacteria like Prevotella species and aerobic bacteria like S. aureus. Symptoms vary from indolent over weeks to acute, with subacute onset associated with aspiration.
Common suppurative diseases of lung- Bronchiectasis...!Sharmin Susiwala
Bronchiectasis is a condition characterized by irreversible dilation of part of the bronchial tree due to damage to elastic and muscular components, usually from acute or chronic infection. It requires both an infectious insult and impaired drainage or airway obstruction. Symptoms include daily cough and sputum production. Diagnosis involves chest imaging showing abnormal lung signs and high-resolution CT scanning. Treatment focuses on controlling infections with antibiotics and clearing secretions. Complications can include lung damage and recurrent pneumonia.
A pneumothorax is the presence of air or gas in the pleural cavity between the lung and chest wall. There are several types, including primary spontaneous pneumothorax which occurs without underlying lung disease, and secondary spontaneous pneumothorax which occurs in people with lung diseases. Pneumothoraces can be caused by medical procedures, trauma, or certain medical conditions. Symptoms include chest pain and shortness of breath. Diagnosis involves physical exam, chest x-ray, and ultrasound. Treatment depends on severity and includes chest tube insertion, surgery, or observation for mild cases.
Pneumothorax is the presence of air in the pleural space. It can be classified as closed, open, or tension pneumothorax. The annual incidence is around 9 per 100,000 people. Risk factors include being a tall, thin male aged 20-40 who smokes cigarettes. Symptoms include chest pain and breathlessness. Chest x-ray is used for diagnosis and can classify pneumothorax as small or large based on rim size. Needle decompression is immediately needed for tension pneumothorax. Oxygen, aspiration, chest drain insertion, and surgery are treatment options depending on the severity of the case.
The document discusses pneumothorax, including its definition, pathophysiology, etiology, clinical manifestations, investigations, and management. Pneumothorax is defined as the presence of air in the pleural space. It can occur spontaneously due to ruptured blebs or bullae, or due to trauma. Clinical manifestations include dyspnea, chest pain, and decreased breath sounds on examination. Chest x-ray and CT scan are used to diagnose and characterize pneumothorax. Management involves oxygen therapy, needle aspiration, chest tube drainage, and chemical pleurodesis to promote lung re-expansion and prevent recurrence.
Pneumothorax is the presence of air in the pleural space and can be spontaneous, due to trauma, or iatrogenic. It is classified as primary spontaneous which occurs without lung disease usually in young males, secondary spontaneous which occurs with underlying lung pathology, or traumatic. Types include closed which seals off, open with a bronchopleural fistula, and tension which increases pressure. Clinical features include chest pain and shortness of breath. Diagnosis is made with chest x-ray showing increased radiolucency. Small primary pneumothoraces may resolve on their own while secondary pneumothoraces and those with symptoms require tube thoracostomy drainage. Recurrent cases require pleurodesis or surgery.
- Hemoptysis is the expectoration of blood from the respiratory tract below the level of the vocal cords. It can range from blood-streaked sputum to gross blood. It is classified as minor (<20mL/day), moderate (20-100mL/day), or massive (100-600mL/day).
- The bronchial arteries, which arise from the aorta, are responsible for 95% of hemoptysis cases as they have higher systemic pressure. The pulmonary arteries have lower pressure and carry only a small portion of cardiac output.
- Common causes of hemoptysis include tuberculosis, bronchiectasis, mycetoma, lung abscess, mitral stenosis, and
The document discusses lung abscess, including its definition, classification, microbiology, risk factors, pathophysiology, clinical features, diagnosis and treatment. A lung abscess is a microbial infection that causes necrosis of lung tissue, forming a cavity. It is usually caused by aspiration of oral anaerobic bacteria. Symptoms include cough, sputum production and fever. Diagnosis involves imaging showing a cavity with an air-fluid level. Treatment involves long-term antibiotics targeting the causative bacteria. Surgery is rarely needed except for failure of medical management or an underlying condition.
Common suppurative diseases of lung- Bronchiectasis...!Sharmin Susiwala
Bronchiectasis is a condition characterized by irreversible dilation of part of the bronchial tree due to damage to elastic and muscular components, usually from acute or chronic infection. It requires both an infectious insult and impaired drainage or airway obstruction. Symptoms include daily cough and sputum production. Diagnosis involves chest imaging showing abnormal lung signs and high-resolution CT scanning. Treatment focuses on controlling infections with antibiotics and clearing secretions. Complications can include lung damage and recurrent pneumonia.
A pneumothorax is the presence of air or gas in the pleural cavity between the lung and chest wall. There are several types, including primary spontaneous pneumothorax which occurs without underlying lung disease, and secondary spontaneous pneumothorax which occurs in people with lung diseases. Pneumothoraces can be caused by medical procedures, trauma, or certain medical conditions. Symptoms include chest pain and shortness of breath. Diagnosis involves physical exam, chest x-ray, and ultrasound. Treatment depends on severity and includes chest tube insertion, surgery, or observation for mild cases.
Pneumothorax is the presence of air in the pleural space. It can be classified as closed, open, or tension pneumothorax. The annual incidence is around 9 per 100,000 people. Risk factors include being a tall, thin male aged 20-40 who smokes cigarettes. Symptoms include chest pain and breathlessness. Chest x-ray is used for diagnosis and can classify pneumothorax as small or large based on rim size. Needle decompression is immediately needed for tension pneumothorax. Oxygen, aspiration, chest drain insertion, and surgery are treatment options depending on the severity of the case.
The document discusses pneumothorax, including its definition, pathophysiology, etiology, clinical manifestations, investigations, and management. Pneumothorax is defined as the presence of air in the pleural space. It can occur spontaneously due to ruptured blebs or bullae, or due to trauma. Clinical manifestations include dyspnea, chest pain, and decreased breath sounds on examination. Chest x-ray and CT scan are used to diagnose and characterize pneumothorax. Management involves oxygen therapy, needle aspiration, chest tube drainage, and chemical pleurodesis to promote lung re-expansion and prevent recurrence.
Pneumothorax is the presence of air in the pleural space and can be spontaneous, due to trauma, or iatrogenic. It is classified as primary spontaneous which occurs without lung disease usually in young males, secondary spontaneous which occurs with underlying lung pathology, or traumatic. Types include closed which seals off, open with a bronchopleural fistula, and tension which increases pressure. Clinical features include chest pain and shortness of breath. Diagnosis is made with chest x-ray showing increased radiolucency. Small primary pneumothoraces may resolve on their own while secondary pneumothoraces and those with symptoms require tube thoracostomy drainage. Recurrent cases require pleurodesis or surgery.
- Hemoptysis is the expectoration of blood from the respiratory tract below the level of the vocal cords. It can range from blood-streaked sputum to gross blood. It is classified as minor (<20mL/day), moderate (20-100mL/day), or massive (100-600mL/day).
- The bronchial arteries, which arise from the aorta, are responsible for 95% of hemoptysis cases as they have higher systemic pressure. The pulmonary arteries have lower pressure and carry only a small portion of cardiac output.
- Common causes of hemoptysis include tuberculosis, bronchiectasis, mycetoma, lung abscess, mitral stenosis, and
The document discusses lung abscess, including its definition, classification, microbiology, risk factors, pathophysiology, clinical features, diagnosis and treatment. A lung abscess is a microbial infection that causes necrosis of lung tissue, forming a cavity. It is usually caused by aspiration of oral anaerobic bacteria. Symptoms include cough, sputum production and fever. Diagnosis involves imaging showing a cavity with an air-fluid level. Treatment involves long-term antibiotics targeting the causative bacteria. Surgery is rarely needed except for failure of medical management or an underlying condition.
Pleural effusion occurs when there is an imbalance between the formation and absorption of fluid in the pleural space. This document outlines the classification, pathogenesis, etiologies, clinical features, diagnosis, and management of pleural effusions. Pleural effusions are classified as transudative or exudative based on the composition of the pleural fluid and the mechanism causing it. Diagnosis involves chest x-ray, ultrasound or CT scan followed by diagnostic thoracentesis of the pleural fluid. Management depends on the underlying cause but may include supportive care, antibiotics, diuretics, chest tube placement, or chemical pleurodesis.
This document provides an overview of pulmonary cysts and how to differentiate them from other air-filled lung lesions using computed tomography (CT) imaging. It outlines an algorithmic approach involving 5 steps to identify cystic lung diseases based on CT findings. True cysts are defined as round parenchymal spaces surrounded by a thin wall. Other mimics like cavities and emphysema are also described. Cystic lung diseases can present as solitary cysts, subpleural cysts, or multiple intraparenchymal cysts, with or without associated nodules or ground glass opacities. Major cystic lung diseases and their characteristic CT and pathological features are reviewed. Additional testing beyond CT may be needed to
This document provides information on transbronchial lung biopsy (TBLB) including indications, contraindications, equipment needed, techniques, yields, number of specimens, and complications. TBLB is used to diagnose conditions like sarcoidosis, infections, masses and transplant rejection. It has risks of pneumothorax and bleeding that are minimized by using techniques like wedging the bronchoscope and fluoroscopy guidance. The yield depends on the condition but is generally over 75% for infiltrates and 50-60% for tumors, requiring multiple specimens for some conditions. Complications include pneumothorax in 1-4% and bleeding over 50ml in 1-2% of cases.
Lung abscess is characterized by necrosis of pulmonary tissue caused by severe lung infection. Common pathogens are bacteria from the oral cavity or respiratory tract. Symptoms include high fever, cough with purulent sputum, and cavities appearing on x-rays. Treatment involves long-term antibiotics and drainage of pus. Surgery may be needed if the abscess is large or not improving with medical treatment. Bronchiectasis is a chronic lung condition defined by the distention of distal bronchi, often caused by repeated lung infections or obstructions during childhood.
This document discusses dyspnea (shortness of breath). It begins by defining dyspnea as a subjective sensation of breathing that can range from mild discomfort to feelings of suffocation. It is a sign of various disorders that generally indicate inadequate ventilation or insufficient oxygen in the blood. The document then covers the causes, history, physical exam findings, investigations and management of dyspnea.
1. The document discusses spontaneous pneumothorax, focusing on diagnosis and management.
2. Key points covered include risk factors for primary and secondary spontaneous pneumothorax, clinical evaluation, imaging studies, and criteria for determining appropriate treatment including observation, needle aspiration, chest tube insertion, or referral to cardiothoracic surgery.
3. Management decisions are based on whether the pneumothorax is primary or secondary, the patient's symptoms, and the size of the pneumothorax.
This document discusses pneumothorax, which is the presence of air in the pleural space outside the lung. It describes different types of pneumothorax including primary spontaneous, secondary spontaneous, closed, open, and tension pneumothorax. Risk factors, clinical features, diagnosis using chest x-ray, treatment options including chest tube insertion, and postoperative management of chest drains are covered. Surgical intervention is indicated for recurrent pneumothorax or when chest drainage fails.
- Lung abscess is defined as necrosis of lung tissue forming cavities containing necrotic debris caused by microbial infection. It is most commonly caused by aspiration, necrotizing pneumonia, chronic pneumonia, or tuberculosis.
- Symptoms include fever, cough, and shortness of breath. CT scan is the most sensitive imaging method and shows rounded cavities that may contain fluid or air-fluid levels with surrounding consolidation.
- Treatment involves prolonged antibiotics and physiotherapy. Larger abscesses over 4cm have worse prognosis and sometimes require drainage procedures or surgery. Complications can include empyema or bronchopleural fistula.
This document discusses lung abscess, including its definition, causes, microbiology, risk factors, clinical presentation, diagnosis and treatment. A lung abscess is a localized infection and necrosis of lung tissue, often caused by aspiration of oral or gastric contents, that produces a cavity within the lung. It commonly presents with cough, sputum production and fever. Diagnosis is made through chest imaging showing a lung cavity. Treatment involves prolonged use of antibiotics active against the typical bacterial causes, such as clindamycin and metronidazole, for 4-6 weeks.
The document discusses paranasal sinuses and sinusitis. It defines paranasal sinuses as four paired air-filled spaces surrounding the nasal cavity. Sinusitis is an inflammation of the mucous membrane in the sinuses. Sinusitis can be classified based on location of the affected sinus or duration of symptoms. Acute sinusitis lasts less than 4 weeks while chronic sinusitis persists for over 12 weeks. Common causes include viral and bacterial infections, allergies, and structural issues impairing drainage. Symptoms vary depending on the affected sinus. Diagnosis involves medical history, exam, and imaging tests. Treatment focuses on relieving symptoms for acute cases but may involve antibiotics for persistent infections.
Dr. Jakeer Hussain discusses pneumothorax, beginning with an introduction and definition. He then covers the classification of pneumothorax as either spontaneous, traumatic, or iatrogenic. Spontaneous pneumothorax is further classified as primary or secondary. The document discusses signs, symptoms, investigations including x-ray and CT scan findings, differential diagnosis, quantification methods, and various treatment options including observation, oxygen supplementation, needle aspiration, tube thoracostomy, medical or VATS pleurodesis, and open thoracotomy.
The document provides information on acute respiratory distress syndrome (ARDS), including its definition, etiology, pathophysiology, clinical manifestations, complications, diagnostic findings, and collaborative therapy. ARDS is defined as acute respiratory failure caused by damage to the alveolar-capillary membrane, resulting in fluid-filled alveoli. It has three pathophysiology phases: injury/exudative, reparative/proliferative, and fibrotic. Clinical features include hypoxemia, reduced lung compliance, and diffuse pulmonary infiltrates on chest imaging. Treatment involves mechanical ventilation with low tidal volumes, application of PEEP, and prone positioning to improve oxygenation.
Lung abscess is caused by microbial infection that leads to necrosis of lung tissue, forming a cavity. Symptoms include cough, expectoration of purulent sputum, and abnormalities on imaging. Lung abscesses are usually polymicrobial infections from oral anaerobes following aspiration. Risk factors include predisposition to aspiration, poor dental health, and conditions compromising immunity. Diagnosis involves chest imaging showing cavitary lesions and microbiological testing of sputum or lung aspirates. Treatment involves antibiotics and drainage of complications like empyema.
The document presents information about a seminar on Acute Respiratory Distress Syndrome (ARDS). The seminar aims to provide in-depth knowledge of ARDS including defining it, describing the pathophysiology and management. ARDS is a life-threatening condition that prevents enough oxygen from entering the blood. It occurs when the lungs become severely inflamed and fluid builds up in the tiny air sacs of the lungs. The seminar will discuss etiology, risk factors, clinical manifestations, diagnostic evaluation, complications, and the nurse's role in management.
This document defines and describes pneumothorax, including its types, causes, symptoms, diagnosis, and treatment. Pneumothorax is an abnormal collection of air in the pleural space that can cause lung collapse. There are several types, including spontaneous, traumatic, and tension pneumothorax. Symptoms range from chest pain to difficulty breathing. Diagnosis is typically made through chest x-ray showing a pleural line and absence of lung markings. Treatment depends on the size and severity but may include oxygen therapy, chest tube insertion, or surgery.
Empyema is a collection of thick, purulent fluid in the pleural space caused by bacterial pneumonia or lung abscess. It develops in stages from an initial exudative stage with low cellular fluid to a later fibrino-purulent stage with large numbers of white blood cells and fibrin. If not treated, it progresses to an organizing stage where fibrotic tissue forms between the pleural membranes. Symptoms include fever, chest pain, cough and shortness of breath. Diagnosis involves imaging, labs and fluid analysis. Treatment requires antibiotics, drainage of pleural fluid and sometimes surgical drainage or decortication.
Pleural effusion is an accumulation of fluid in the pleural space between the lungs and chest wall. It is usually caused by an underlying condition such as heart failure, pneumonia, cancer, or liver disease. There are two main types of pleural effusions - transudative which contains fluid similar to normal pleural fluid, and exudative which has excess protein or evidence of infection/inflammation. Diagnosis involves imaging tests and analyzing fluid obtained via thoracentesis. Treatment focuses on managing the underlying cause as well as draining large or infected effusions using procedures like thoracentesis, chest tubes, or pleurodesis. Nursing care involves pain management, monitoring drainage systems, and educating patients.
Pneumonia is an infection of the lungs caused by bacteria, viruses or other pathogens. It is commonly transmitted when germs are inhaled into the lungs. Risk factors include impaired immunity, smoking, neurological conditions that impact swallowing, and chronic lung diseases. Diagnosis involves chest x-ray, sputum culture, blood tests and assessment of severity using CURB65 score. Treatment focuses on antibiotics, oxygen supplementation, hydration and symptom relief. Complications can include respiratory failure and sepsis.
This document provides information on lung abscesses, including:
- Dr. David Smith postulated in the 1920s that aspiration of oral bacteria was the main mechanism of lung abscess infection.
- A lung abscess is a localized area of lung tissue destruction greater than 2cm in diameter caused by pyogenic bacterial infection.
- In the pre-antibiotic era, 1/3 of lung abscess patients died, another 1/3 recovered, and the remaining 1/3 developed chronic illnesses.
- Risk factors include dental/sinus infections, impaired swallowing, gastric issues, and pre-existing lung diseases. Common causative organisms are described.
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.
Pleural effusion occurs when there is an imbalance between the formation and absorption of fluid in the pleural space. This document outlines the classification, pathogenesis, etiologies, clinical features, diagnosis, and management of pleural effusions. Pleural effusions are classified as transudative or exudative based on the composition of the pleural fluid and the mechanism causing it. Diagnosis involves chest x-ray, ultrasound or CT scan followed by diagnostic thoracentesis of the pleural fluid. Management depends on the underlying cause but may include supportive care, antibiotics, diuretics, chest tube placement, or chemical pleurodesis.
This document provides an overview of pulmonary cysts and how to differentiate them from other air-filled lung lesions using computed tomography (CT) imaging. It outlines an algorithmic approach involving 5 steps to identify cystic lung diseases based on CT findings. True cysts are defined as round parenchymal spaces surrounded by a thin wall. Other mimics like cavities and emphysema are also described. Cystic lung diseases can present as solitary cysts, subpleural cysts, or multiple intraparenchymal cysts, with or without associated nodules or ground glass opacities. Major cystic lung diseases and their characteristic CT and pathological features are reviewed. Additional testing beyond CT may be needed to
This document provides information on transbronchial lung biopsy (TBLB) including indications, contraindications, equipment needed, techniques, yields, number of specimens, and complications. TBLB is used to diagnose conditions like sarcoidosis, infections, masses and transplant rejection. It has risks of pneumothorax and bleeding that are minimized by using techniques like wedging the bronchoscope and fluoroscopy guidance. The yield depends on the condition but is generally over 75% for infiltrates and 50-60% for tumors, requiring multiple specimens for some conditions. Complications include pneumothorax in 1-4% and bleeding over 50ml in 1-2% of cases.
Lung abscess is characterized by necrosis of pulmonary tissue caused by severe lung infection. Common pathogens are bacteria from the oral cavity or respiratory tract. Symptoms include high fever, cough with purulent sputum, and cavities appearing on x-rays. Treatment involves long-term antibiotics and drainage of pus. Surgery may be needed if the abscess is large or not improving with medical treatment. Bronchiectasis is a chronic lung condition defined by the distention of distal bronchi, often caused by repeated lung infections or obstructions during childhood.
This document discusses dyspnea (shortness of breath). It begins by defining dyspnea as a subjective sensation of breathing that can range from mild discomfort to feelings of suffocation. It is a sign of various disorders that generally indicate inadequate ventilation or insufficient oxygen in the blood. The document then covers the causes, history, physical exam findings, investigations and management of dyspnea.
1. The document discusses spontaneous pneumothorax, focusing on diagnosis and management.
2. Key points covered include risk factors for primary and secondary spontaneous pneumothorax, clinical evaluation, imaging studies, and criteria for determining appropriate treatment including observation, needle aspiration, chest tube insertion, or referral to cardiothoracic surgery.
3. Management decisions are based on whether the pneumothorax is primary or secondary, the patient's symptoms, and the size of the pneumothorax.
This document discusses pneumothorax, which is the presence of air in the pleural space outside the lung. It describes different types of pneumothorax including primary spontaneous, secondary spontaneous, closed, open, and tension pneumothorax. Risk factors, clinical features, diagnosis using chest x-ray, treatment options including chest tube insertion, and postoperative management of chest drains are covered. Surgical intervention is indicated for recurrent pneumothorax or when chest drainage fails.
- Lung abscess is defined as necrosis of lung tissue forming cavities containing necrotic debris caused by microbial infection. It is most commonly caused by aspiration, necrotizing pneumonia, chronic pneumonia, or tuberculosis.
- Symptoms include fever, cough, and shortness of breath. CT scan is the most sensitive imaging method and shows rounded cavities that may contain fluid or air-fluid levels with surrounding consolidation.
- Treatment involves prolonged antibiotics and physiotherapy. Larger abscesses over 4cm have worse prognosis and sometimes require drainage procedures or surgery. Complications can include empyema or bronchopleural fistula.
This document discusses lung abscess, including its definition, causes, microbiology, risk factors, clinical presentation, diagnosis and treatment. A lung abscess is a localized infection and necrosis of lung tissue, often caused by aspiration of oral or gastric contents, that produces a cavity within the lung. It commonly presents with cough, sputum production and fever. Diagnosis is made through chest imaging showing a lung cavity. Treatment involves prolonged use of antibiotics active against the typical bacterial causes, such as clindamycin and metronidazole, for 4-6 weeks.
The document discusses paranasal sinuses and sinusitis. It defines paranasal sinuses as four paired air-filled spaces surrounding the nasal cavity. Sinusitis is an inflammation of the mucous membrane in the sinuses. Sinusitis can be classified based on location of the affected sinus or duration of symptoms. Acute sinusitis lasts less than 4 weeks while chronic sinusitis persists for over 12 weeks. Common causes include viral and bacterial infections, allergies, and structural issues impairing drainage. Symptoms vary depending on the affected sinus. Diagnosis involves medical history, exam, and imaging tests. Treatment focuses on relieving symptoms for acute cases but may involve antibiotics for persistent infections.
Dr. Jakeer Hussain discusses pneumothorax, beginning with an introduction and definition. He then covers the classification of pneumothorax as either spontaneous, traumatic, or iatrogenic. Spontaneous pneumothorax is further classified as primary or secondary. The document discusses signs, symptoms, investigations including x-ray and CT scan findings, differential diagnosis, quantification methods, and various treatment options including observation, oxygen supplementation, needle aspiration, tube thoracostomy, medical or VATS pleurodesis, and open thoracotomy.
The document provides information on acute respiratory distress syndrome (ARDS), including its definition, etiology, pathophysiology, clinical manifestations, complications, diagnostic findings, and collaborative therapy. ARDS is defined as acute respiratory failure caused by damage to the alveolar-capillary membrane, resulting in fluid-filled alveoli. It has three pathophysiology phases: injury/exudative, reparative/proliferative, and fibrotic. Clinical features include hypoxemia, reduced lung compliance, and diffuse pulmonary infiltrates on chest imaging. Treatment involves mechanical ventilation with low tidal volumes, application of PEEP, and prone positioning to improve oxygenation.
Lung abscess is caused by microbial infection that leads to necrosis of lung tissue, forming a cavity. Symptoms include cough, expectoration of purulent sputum, and abnormalities on imaging. Lung abscesses are usually polymicrobial infections from oral anaerobes following aspiration. Risk factors include predisposition to aspiration, poor dental health, and conditions compromising immunity. Diagnosis involves chest imaging showing cavitary lesions and microbiological testing of sputum or lung aspirates. Treatment involves antibiotics and drainage of complications like empyema.
The document presents information about a seminar on Acute Respiratory Distress Syndrome (ARDS). The seminar aims to provide in-depth knowledge of ARDS including defining it, describing the pathophysiology and management. ARDS is a life-threatening condition that prevents enough oxygen from entering the blood. It occurs when the lungs become severely inflamed and fluid builds up in the tiny air sacs of the lungs. The seminar will discuss etiology, risk factors, clinical manifestations, diagnostic evaluation, complications, and the nurse's role in management.
This document defines and describes pneumothorax, including its types, causes, symptoms, diagnosis, and treatment. Pneumothorax is an abnormal collection of air in the pleural space that can cause lung collapse. There are several types, including spontaneous, traumatic, and tension pneumothorax. Symptoms range from chest pain to difficulty breathing. Diagnosis is typically made through chest x-ray showing a pleural line and absence of lung markings. Treatment depends on the size and severity but may include oxygen therapy, chest tube insertion, or surgery.
Empyema is a collection of thick, purulent fluid in the pleural space caused by bacterial pneumonia or lung abscess. It develops in stages from an initial exudative stage with low cellular fluid to a later fibrino-purulent stage with large numbers of white blood cells and fibrin. If not treated, it progresses to an organizing stage where fibrotic tissue forms between the pleural membranes. Symptoms include fever, chest pain, cough and shortness of breath. Diagnosis involves imaging, labs and fluid analysis. Treatment requires antibiotics, drainage of pleural fluid and sometimes surgical drainage or decortication.
Pleural effusion is an accumulation of fluid in the pleural space between the lungs and chest wall. It is usually caused by an underlying condition such as heart failure, pneumonia, cancer, or liver disease. There are two main types of pleural effusions - transudative which contains fluid similar to normal pleural fluid, and exudative which has excess protein or evidence of infection/inflammation. Diagnosis involves imaging tests and analyzing fluid obtained via thoracentesis. Treatment focuses on managing the underlying cause as well as draining large or infected effusions using procedures like thoracentesis, chest tubes, or pleurodesis. Nursing care involves pain management, monitoring drainage systems, and educating patients.
Pneumonia is an infection of the lungs caused by bacteria, viruses or other pathogens. It is commonly transmitted when germs are inhaled into the lungs. Risk factors include impaired immunity, smoking, neurological conditions that impact swallowing, and chronic lung diseases. Diagnosis involves chest x-ray, sputum culture, blood tests and assessment of severity using CURB65 score. Treatment focuses on antibiotics, oxygen supplementation, hydration and symptom relief. Complications can include respiratory failure and sepsis.
This document provides information on lung abscesses, including:
- Dr. David Smith postulated in the 1920s that aspiration of oral bacteria was the main mechanism of lung abscess infection.
- A lung abscess is a localized area of lung tissue destruction greater than 2cm in diameter caused by pyogenic bacterial infection.
- In the pre-antibiotic era, 1/3 of lung abscess patients died, another 1/3 recovered, and the remaining 1/3 developed chronic illnesses.
- Risk factors include dental/sinus infections, impaired swallowing, gastric issues, and pre-existing lung diseases. Common causative organisms are described.
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.
Lung abscess is a necrotic pulmonary infection that forms cavities containing fluid or debris. It is usually caused by microbial infection following aspiration or pneumonia. Without treatment, lung abscess was often fatal, but antibiotics have greatly improved outcomes. Most lung abscesses are now cured with prolonged antibiotic therapy targeting the usual culprits of anaerobic bacteria and occasionally aerobic pathogens. Imaging helps confirm the diagnosis and monitor response to medical management, with surgery rarely needed for uncomplicated cases.
Diseases of the lungs, especially pneumonia, are leading causes of pediatric morbidity and mortality. Pneumonia is often treated successfully with antibiotics by pediatricians, but sometimes leads to complications requiring surgery. Common complications of bacterial pneumonia include lung abscesses, pleural effusions, pyothorax (pus in the pleural cavity), and pyopneumothorax (pus and air in the pleural cavity). These complications are treated through drainage procedures, antibiotics, and addressing the underlying infection.
Bacterial destruction of the lungs can lead to serious complications like lung abscesses and pleural effusions. Lung abscesses form when bacteria destroy lung tissue, causing necrosis and pus-filled cavities. Left untreated, the abscess can drain into the pleural cavity, causing a pleural effusion. Pleural effusions are accumulations of fluid in the pleural space that can become infected (pyothorax) or allow air to enter (pyopneumothorax), requiring drainage to prevent respiratory distress. Proper treatment involves identifying the underlying infection through testing of pleural fluid, administering antibiotics, and draining excess fluid or air in the pleural cavity through chest tubes or thoracentesis.
Lung abscess is a localized area of lung destruction caused by infection, typically by aspiration of oropharyngeal bacteria. It appears on imaging as a cavity containing air-fluid levels. The infection can start as necrotizing pneumonia that progresses to microabscesses and larger cavitary lesions over time. Risk factors include dental/sinus infections, impaired swallowing, or pre-existing lung disease. Treatment involves antibiotics targeting common aerobic and anaerobic bacteria. Therapy typically lasts 4-6 weeks until imaging shows resolution, though surgery may be needed for large or resistant abscesses. Complications can include empyema, bronchopleural fistula, or distant infections if not properly treated.
Lung abscess is defined as necrosis of pulmonary tissue and formation of cavities containing necrotic debris or fluid, usually caused by microbial infection. It commonly results from aspiration of oropharyngeal contents colonized with anaerobic bacteria. Patients often present with nonspecific symptoms like fever, cough, sputum production, and weight loss. Physical exam may reveal consolidation and signs of any associated pleural effusions or pneumothoraces. Treatment involves prolonged antibiotic therapy, though surgery was historically used. Failure to treat lung abscess is associated with poor clinical outcomes.
Лекция. Абсцесс и гангрена легких. Abscess, lung gangrene англ..pptUpasana399630
This document discusses abscesses and gangrene of the lungs. It defines lung abscess as a pus-filled cavity in the lung bounded by granulation tissue, and gangrene of the lung as purulent-necrotic disintegration of lung tissue not separated by a capsule. Common causes are Staphylococcus and other bacteria. Abscesses form from acute infection or blood supply issues. Clinical presentation includes fever, cough, and deterioration. Treatment involves antibiotics, drainage, and sometimes surgery. Outcomes range from complete recovery to high mortality in gangrene.
This document discusses lung abscess, including definitions, classifications, causes, risk factors, clinical manifestations, investigations, and management. It begins with defining pneumonia and classifying it based on anatomy and pathogen. Common causes of pneumonia by age group and risk factors are discussed. Clinical manifestations of pneumonia include fever, cough, chest pain, and dyspnea. The document then defines a lung abscess and classifies it as acute or chronic based on duration and etiology. Causes include aspiration, bronchial obstruction, and spread from other sites of infection. Risk factors for gram-negative colonization are listed. Symptoms of a lung abscess include cough, foul sputum, hemoptysis, and chest pain. Invest
1. Lung abscess is a localized necrotic lesion in the lung tissue containing pus, generally caused by aspiration of anaerobic bacteria. It starts as pneumonia, with areas of lung tissue dying off and forming cavities containing pus.
2. Symptoms include fever, cough, sputum production, and chest pain. Diagnosis involves chest x-rays and CT scans to identify fluid-filled cavities.
3. Treatment depends on the size and includes antibiotics, drainage of large abscesses through the chest wall, and surgery if complications occur.
This document discusses pneumonia, including its definition, causes, risk factors, diagnosis, and treatment. Pneumonia is an inflammation of the lungs caused by an infectious agent. Microorganisms can gain access to the lungs through various routes like aspiration or inhalation. The lungs are vulnerable because of their gas exchange function. Clinical features include cough, dyspnea, fever, and chest pain. Pneumonia is diagnosed based on clinical symptoms and chest x-ray findings. Community-acquired pneumonia is the most common type and is usually bacterial in nature.
Bronchiectasis is a lung condition characterized by abnormal dilation of the bronchi. It is usually caused by damage to the airways from childhood infections. Symptoms include chronic cough and mucus production. Diagnosis involves chest imaging like CT scans to view the dilated airways. Treatment focuses on controlling infections with antibiotics, reducing inflammation, and improving lung cleansing through airway clearance techniques. In more severe cases, surgery may be used to remove diseased portions of the lung.
This document discusses pneumonia and emphysema. It provides details on pneumonia, including the pathogenesis, etiology, classification, and features of lobar pneumonia. Pneumonia is defined as acute lung inflammation distal to the terminal bronchioles. It is commonly caused by bacteria, viruses, or other factors. Lobar pneumonia specifically involves inflammation of an entire lung lobe. It is usually caused by Streptococcus pneumoniae and presents as distinct pathological phases from congestion to resolution. Complications can include organization of exudate, pleural effusions, empyema, or lung abscesses.
Pulmonary abscesses are necrotizing lung infections usually caused by aspiration of oral or gastric contents. Common pathogens include anaerobic bacteria from the mouth or enteric gram-negative bacilli in elderly patients. There are three main types: aspiration lung abscess caused by unconscious aspiration, secondary lung abscess caused by underlying conditions, and hematogenous lung abscess from distant infections. Symptoms include fever, cough with purulent sputum, chest pain, and potential hemoptysis. Diagnosis involves chest imaging showing cavitary lesions and microbiological testing of sputum or biopsy samples. Treatment primarily involves prolonged courses of antibiotics along with drainage procedures in some cases.
Lung abscess is a localized area of lung parenchyma destruction greater than 2 cm in diameter caused by pyogenic infection. It is usually the result of aspiration of oropharyngeal or gastric contents but can also develop from necrotizing pneumonia, bronchial obstruction, or hematogenous spread. Common pathogens include anaerobic bacteria such as Prevotella species and aerobic bacteria like Staphylococcus aureus. Symptoms, imaging, and microbiological testing are required to diagnose lung abscess.
Lung abscess is a localized area of lung parenchyma destruction greater than 2 cm in diameter caused by pyogenic bacterial infection. It is usually the result of aspiration of oropharyngeal or gastric contents but can also develop from necrotizing pneumonia, bronchial obstruction, or hematogenous spread. Common pathogens include anaerobic bacteria such as Prevotella species and aerobic bacteria like Staphylococcus aureus. Symptoms, imaging findings, and microbiology help characterize lung abscesses as either acute or chronic.
1) Emphysema, chronic bronchitis, asthma, and bronchiectasis are obstructive lung diseases. Emphysema and chronic bronchitis are often grouped together as chronic obstructive pulmonary disease (COPD) since most patients have features of both, likely due to cigarette smoking.
2) COPD is a major public health problem and the fifth leading cause of death worldwide. Heavy cigarette smoking and environmental pollutants are significant risk factors.
3) Emphysema is characterized by irreversible destruction of lung tissue and airspace enlargement. It is classified according to anatomical location within the lung lobe. Chronic bronchitis involves inflammation and mucus buildup in the bronchi.
This document provides information on lower respiratory tract infections (LRTI) in children, specifically acute bronchitis, bronchiolitis, and pneumonia. It defines each condition, discusses causes and risk factors, clinical presentation, diagnostic testing, and treatment approaches. Acute bronchitis involves inflammation of the bronchi and causes symptoms like cough and wheezing. Bronchiolitis commonly affects infants under 6 months and is usually caused by viruses like RSV. Pneumonia can be bacterial, viral, fungal, or other causes, and manifests as inflammation and consolidation in the lungs. Diagnosis is based on symptoms, chest x-ray, and microbiological testing. Management involves antibiotics, antivirals, or antifung
This document discusses various pulmonary infections including viruses, bacteria, fungi, and their classifications. It describes bronchopneumonia as a patchy pneumonia localized around bronchioles and surrounding alveoli. Lobar pneumonia involves consolidation of an entire lobe and is often caused by pneumococcus. Interstitial pneumonia shows inflammation predominantly in alveolar walls. The document outlines etiologies, pathogenesis, histopathology, and clinical features of different pulmonary infections.
Bronchiectasis, lung abscess, and empyema are suppurative lung diseases characterized by the presence of pus within the lung parenchyma. Bronchiectasis is abnormal, permanent dilation of the bronchi caused by destruction of bronchial walls, often secondary to infection. Lung abscess is a localized, suppurative cavity in the lung caused by conditions like pneumonia or aspiration. Empyema is pus within the pleural space caused by spread of infection from pneumonia or a lung abscess into the pleural space. These conditions are diagnosed through imaging, sputum analysis, and other tests and treated with antibiotics, drainage procedures, or surgery depending on the severity and cause of infection.
The document discusses pleural disease and pleural effusions. It covers pleural anatomy, physiology of pleural fluid formation and drainage, diagnostic evaluation of pleural effusions including physical exam, imaging like chest x-ray and CT, and diagnostic thoracentesis. Pleural effusions are classified as transudative or exudative. Common causes of exudative pleural effusions include infections like tuberculosis, malignancy, heart failure, and pulmonary embolism.
The document discusses lung tumors and lung cancer. It describes that lung neoplasms can be benign or malignant. Benign lung tumors are commonly asymptomatic and incidentally found on imaging. They are divided into epithelial and non-epithelial tumors, with hamartomas making up about 50% of benign lung neoplasms. The document then discusses the classification, characteristics, and treatment of various benign lung tumors such as papillomas, micronodular pneumocyte hyperplasia, and hamartomas. It also provides details on the epidemiology, risk factors, histological types including adenocarcinoma and small cell lung cancer, etiology related to smoking, and clinical presentation of lung cancer.
Chronic obstructive pulmonary disease (COPD) represents a major global health challenge. It is currently the fourth leading cause of death worldwide but is projected to become the third leading cause by 2020. The document defines COPD and discusses its types, risk factors, pathogenesis, clinical features, diagnosis, and management. The two main types are chronic bronchitis and emphysema. Smoking is the most important risk factor but other factors like indoor and outdoor air pollution also contribute to the disease burden. Symptoms include dyspnea, chronic cough, and sputum production. Spirometry is required to diagnose COPD by demonstrating airflow limitation.
Hemoptysis is defined as coughing up blood originating from below the vocal cords. It can range from mild blood streaking to over 600ml of blood loss in 24 hours (massive hemoptysis). The causes of hemoptysis are numerous but the most common causes of massive hemoptysis are active tuberculosis, bronchiectasis, mycetoma, and bronchogenic carcinoma. The initial evaluation of a patient with hemoptysis involves obtaining a detailed history, physical exam, and basic laboratory tests to determine the severity and potential causes. Further diagnostic tests may then be used to confirm the diagnosis.
Tobacco originated in North and South America and was used by indigenous peoples for medicinal, religious, and cultural purposes. It was introduced to Europe in the 15th century and grew rapidly in popularity. By the late 19th century, automated cigarette machines were mass producing cigarettes. Cigarettes contain over 4000 chemicals, including 60 carcinogens. Smoking causes numerous health consequences like cancer, heart disease, stroke, and premature death. Quitting smoking at any age can significantly reduce health risks.
Tobacco originated in North and South America and was first used by indigenous peoples for medicinal and religious purposes. It was introduced to Europe in the 15th century and its smoking became widespread. Over time, the mass production of cigarettes led to tobacco becoming very prevalent globally. Smoking tobacco causes significant negative health consequences, including various cancers and heart and lung diseases. It also shortens lifespans considerably. Quitting smoking at any age can improve health outcomes.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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2. Definition
A lung abscess is a localized area of destruction of lung parenchyma
(usually >2 cm in diameter) in which infection by pyogenic organisms
results in tissue necrosis and suppuration manifested radiologically as
a cavity with air fluid level.
3. Classification
Lung abscess may be single or multiple and they frequently contain
air-fluid levels
When multiple and smal(<2 cm in diameter) they are sometimes
referred to as necrotizing or suppurative pneumonia
The formation of multiple small (<2 cm) abscesses is occasionally
referred to as necrotizing pneumonia or lung gangrene
5. Classification…
Clinically useful during initial evaluation
Acute:
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 (e.g. S. aureus)
7. Classification…
Clinically useful during initial evaluation
Chronic:
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
8. Classification…
Primary abscess is infectious in origin, caused by aspiration or
pneumonia in the healthy host. Mostly result from necrosis in
an existing parenchymal process, usually untreated or
aspiration pneumonia
9. Classification…
Secondary abscess is caused by
Pre-existing condition eg bronchiectasis
Bronchial obstruction (eg- aspirated foreign body)
An immuno-compromised state
Spread from an extra-pulmonary site
Abscess that complicates either a septic vascular embolus (eg- right
sided endocarditis)
10. Classification…
Lung abscesses can be further characterized by the responsible
pathogen, such as Staphylococcus lung abscess & anaerobic or
Aspergillus lung abscess.
Most common anaerobe identified was Prevotella species.
Most common aerobes identified were S. viridans, Staphyloccus
species.
11. Classification…
In a series of patients with acute community acquired lung abscess
anaerobes isolated alone in 44% cases
mixed aerobes & anaerobes in 22%
aerobes alone in 19%
the remaining cases were caused by an unidentified pathogens or
M. tuberculosis
14. Demographic Profile
Age
Lung abscesses likely to occur more commonly in elderly
patients because of
Increased incidence of periodontal disease
Increased prevalence of dysphagia
Aspiration
Sex
A male predominance is reported in published case series.
15. Common sites
Abscesses generally develop in the right lung
Posterior segment of the right upper lobe is affected most
commonly
Followed by the apical segment of either lower lobe or both.
If the patient is lying on his/her side
The posterolateral parts of the upper lobe tend to receive the
aspirate
When aspiration has occurred with the patient lying supine
The apicalsegments of the lower lobes tend to receive the aspirate
18. Causesof Lung abscess(A) Aspiration
A)Aspiration of infected material containing oropharyngeal
flora (commonest cause (
Organisms are anaerobic and aerobic
May be due to
Dental/ periodontal sepsis esp following tooth
extraction, tonsillectomy and nasal operation
Paranasal sinus infection
29. Pathology
Lung abscesses begin as 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 of damage.
However, if treatment is delayed or inadequate, the inflammatory
process may progress, entering a more chronic phase.
30. Pathology…
Bronchi adjacent to the area of inflammation may become eroded
so that part of the purulent contents of the abscess may be
expectorated as foul sputum.
Fibrosis may occur in and around the abscess cavity, which may
become loculated and walled off by dense scar tissue.
Spillage of pus into the bronchial tree may serve to disseminate
infection either to other parts of the same lung or to the opposite
lung.
31. Pathology…
The extent to which this suppurative process continues can be checked by antibiotics.
These may sterilize the abscess cavity so that granulation tissue forms over the fibrous
tissue, this then becoming covered by squamous or ciliated columnar epithelium that
grows in form adjacent bronchi.
Abscesses arising as a result of aspiration usually occur close to the visceral pleural
surface in dependent parts of the lungs.
In a study by Brock, it has been shown that three-quarters of lung abscesses occur in
the posterior segment of the right upper lobe or the apical segments of the either lower
lobe (due to anatomical disposition, these segmental bronchi accept the passage of
aspirated liquid in the supine position most readily(.
32. Pathology…
Lung abscess that occur as a result of haematogenous spread may be found in any
part of the lungs.
Despite the close proximity of lung abscesses to the visceral pleura, resultant
empyema is not the rule, occurring in less than one-third of cases.
34. Organisms commonly isolated…
Anaerobes – are usually part of a polymicrobial flora . Anaerobic
bacterial commonly cause necrotizing pneumonia. Either as primary
pathogen Or in combination with aerobic bacteria. The main groups of
anaerobes are as follows.
1Gram-negative bacilli making up the genus Bacteroides,notably
Bacteroides fragilis. Prevotella and Porphyromonas.
2Gram-positive cocci, mainly Peptostreptococcus and anaerobic or
microaerophilic streptococci.
3Long thin Gram-negative rods comprising Fusobacterium species,
particularly F. nucleatum and F. necrophorum.
35. Organisms commonly isolated…
Aerobic: Aerobic organisms tend to cause lung abscesses as part of a
necrotizing pneumonia that can be seen to be radiographically more diffuse than
is the case with classical anaerobic lung abscess, in which the surrounding lung
parenchyma may appear relatively normal on the chest film.
Gram-positive aerobes
Staph. aureus , Strep. pyogenes (syn. Group A streptococcus, β haemolytic
streptococcus) , Strep. pneumoniae , Strep. intermedius, Strep. constellatus and
Strep. Anginosus.
Gram-negative aerobes
Klebsiella pneumoniae, Pseudomonas aeruginosa , Haemophilus influenzae,
Escherichia coli, Acinetobacter species, Proteus species and Legionella
species.
36. Organisms commonly isolated…
Mixed –
Common
In majority of cases, a mixed
bacterial flora can be found.
Mycobacteria (rare)
Mycobacterium
tuberculosis
Mycobacterium kansasii
Mycobacterium intracellularis
Fungus
Histoplasmosis
Aspergillosis
Coccidiodes
Cryptococcus
Parasites
Entamoeba histolytica
Paragonimus westermanii
39. Symptoms
The presenting features of lung abscesses vary
considerably
Presentation may be indolent over several weeks
or months
or acute
A subacute onset may be associated with presumed
aspiration
40. Symptoms …
The illness also tends to be more abrupt and severe
when lung abscesses arise as a consequence of necrotizing
pneumonia caused by predominantly aerobic organisms
(eg- Staph. aureus or K. pneumoniae)
41. Symptoms …
Patients present with
Severe cough 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
42. Symptoms …
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
43. Symptoms …
In most patients, presentation is insidious with symptoms lasting at
least 2weeks before presentation
History
Includes risk factors for aspiration, eg-
Alcoholism
Drug overdose
Seizures
Head injury
Stroke
Absence of such risk factors should prompt a search for a diagnosis
other than primary lung abscess
44. Signs
There is no signs specific for lung abscess
Patient is toxic with high temperature & Halitosis
Clubbing may develop withinfew weeks if treatment is
inadequate
usually in 10% cases after 3 weeks
45. Signs…
On chest exam
Evidence of consolidation
Dullness to percussion and diminished breath sounds, if the abscess
is large and situated near the surface of the lung
The ‘amorphic’ or ‘cavernous’ breath sound traditionally
associated
with lung cavities are rarely elicited in modern practice
50. Imaging Studies…
X-ray chest
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
51. Imaging Studies
Cavity with air-fluid level is seen after burst
More on right side
CXR
Lung abscess as a result of aspiration most frequently occur in the
posterior segments of the upper lobes or the superior segments of the
lower lobe.
52. Abscess cavities may be large
and are sometimes multilocular with several different fluid levels
within one opacity
54. Imaging Studies
The abscess may extend to the pleural surface, in which
case it forms acute angles with the pleural surface
Up to one third of lung abscesses may be accompanied by
an empyema
55.
56.
57.
58. CT scan of the thorax (right upper lobe) shows a thick-walled cavity
with
59.
60. Imaging Studies/ carcinoma
The cavity wall can be smooth or ragged
but less commonly nodular which raises the possibility of cavitating
carcinoma
carcinoma
Size of the cavity may be helpful in distinguishing neoplastic from non-
neoplastic lung abscesses
Minimal inflammation surrounding the abscess on radiographs suggest
an underlying neoplasm
Bronchial carcinoma & lung abscess may coexist in as many as 12% of
cases
61. Imaging Studies
If a lung abscess fails to communicate with a bronchus, the
characteristic air-fluid level within a cavity will not be seen
radiographically
in this case, the radiographic appearance is one of a focal, ground-
glass infiltrate with indistinct borders
This may be seen early in the disease because it takes 8 to 14 days
for tissue necrosis with abscess formation to develop
However, tissue breakdown should be evident
62. Imaging Studies
As a lung abscess heals, first the pneumonic infiltrate resolves
during this process the wall of the abscess cavity typically becomes
thinner
diminishing in size until it is no longer detectable
63. Imaging Studies
The wall thickness of a lung abscess progresses from
thick to thin
and from ill-defined to well-circumscribed as the
surrounding lung infection resolves
64. Imaging Studies
In a study of 71 patients
13% of lung abscess cavities had disappeared in 2weeks
44% in 4 weeks
59% in 6 weeks
and 70% within 3 months after treatment with appropriate
antibiotics
There is residual chest radiographic shadowing when
extensive fibrosis has occurred
65. Imaging Studies
Rarely multiple cavities on CXR, a rare findings in an anaerobic
process
may be complicated by immunosuppression, recurrent aspiration or
virulent anaerobe(s) causing a necrotizing pneumonitis
Occasionally, the radiographic features of complications may be
evident, including – effusion, empyema, pneumothorax etc
66. Imaging Studies/ Thoracic CT
Better in lung anatomy visualization to identify empyema
from lung abscess
An abscess is rounded radio-lucent lesion with a thin wall
& ill-defined irregular margins
67. Imaging Studies/ Thoracic CT
Thoracic CT may be very helpful in accurately defining the
extent and disposition of both lung abscesses and empyemas
Also may demonstrate the multiple small air cavities of
necrotizing pneumonia
Ultrasound or CT may also be helpful in guiding percutaneous
diagnostic thin-needle aspiration of lung abscesses
68. Imaging Studies
When the CXR cannot distinguish lung abscess from infected bulla/
empyema
CT suggests
A lung abscess
is a thick, irregular walled cavity
with no associated lung compression
Empyema
usually is characterized by thin, smooth walls
with compression of uninvolved lung
70. Lung abscess Empyema Infected bullae
is a thick, irregular
walled cavity
with no associated
lung compression
lung usually is
characterized by
thin, smooth walls
with compression
of uninvolved lung
usually is
characterized by thin,
smooth walls
with compression of
uninvolved lung
minimal
surrounding
inflammation
71. Criteria For Fiberoptic Bronchoscopy In Patients With Lung
Abscess
Atypical presentation
1. Absence of fever
2. White blood cell count
less 11000/mm3
3. Absence of systemic
symptoms
4. Fulminant course
5. Absence of predisposing
factors for aspiration
6. Atypical abscess location
7. Abscess formation in an
edentulous patient
Failure to respond to
antibiotics
1. Mediastinal adenopathy
2. Suspected underlying
malignancy
3. Suspected foreign body
72. Investigations/FOB (Contd)
Criteria for Bronchoscopy to exclude an underlying carcinoma in
patients with lung cavities
Mean oral temp <100 ºF
Absence of systemic symptoms
Absence of predisposing factors for aspiration, and
Mean leukocyte count >11ooo/mm3
When more than 3 of these factors are present in a patient with lung
abscess, an underlying carcinoma is likely
73. Investigations/FOB (Contd)
Bronchoscope is no longer routinely used for abscess drainage,
because the majority spontaneously communicate with the airways
& drain
It is also possible to rupture an abscess during bronchoscopy and
communicate previously uninvolved lung segment
74. Investigations/FOB (Contd)
Bronchoscope is no longer routinely used for abscess drainage,
because the majority spontaneously communicate with the airways
& drain
It is also possible to rupture an abscess during bronchoscopy and
communicate previously uninvolved lung segment
75. Investigations…/Sputum examination
Sputum examination
Gram staining & C/S (both aerobic & anaerobic)
Repeated isolation of a predominant organism suggests that this
may be a true pathogen
ZN stain for AFB and AFB C/S
GXP for MTB/Rif
cytology for malignant cell
Stain and culture for Fungus
76. Investigations
Blood culture may be helpful in establishing the etiology
If abscess is associated with an empyema (as in the case
30% of the time), culture of empyema fluid may yield reliable
bacteriological data
77. Investigations(Contd(
Blood cultures should be taken, as pathogens are occasionally
isolated in cases of blood-borne (or ‘metastatic’) lung abscess or
when the abscess has complicated pneumonia.
Positive blood cultures are unusual in anaerobic infection.
Serology may sometimes be helpful, especially to exclude hydatid
disease or amoebiasis.
More invasive methods of microbiological diagnosis (transtracheal
aspiration & bronchoscopy) are rarely used, esp. if the presentation
is atypical or the patient is not responding to therapy.
78. Investigations (Contd)
Other methods of obtaining specimens
CT/ USG guided Percutaneous needle aspiration /FNAC
of a lung abscess
FOB for Bronchoalveolar lavage , brushing &
biopsy
Pleural fluid aspiration (if empyema present)
79. Characteristics of sputum in lung abscess
If the sputum is kept in a bottle, there are 3 layers
Upper – Frothy
Middle – thick liquid
Lower – sediment (epithelial debris, bacteria)
82. Differential diagnosis
/Clinically
Consolidation (during resolution stage), usually no clubbing
Bronchiectasis
Bronchial carcinoma, usually Squamous cell carcinoma
Pulmonary tuberculosis (without causing abscess)
Rare infections, including – Actinomycosis, Nocardiasis,
Fungal pneumonia
83. Differential diagnosis(Contd)
In Lung abscess
Fever, systemic complaints
purulent sputum
and WBC count >11x109/L more likely to be
found
Response to antibiotic therapy
84. Differential diagnosis…/Radiologically
Necrosis in a lung tumour
Age more than 50 years
No history suggestive of
aspiration
Lesions need not be situated
in a typically dependent segment of
the lung
In CXR: an eccentric cavity
with thick irregular walls
85. Differential diagnosis…/Radiologically
Lung cancer and lung abscess may occur together, particularly
in
elderly patients
necrotic tissue in a tumour may become infected
as well as the tumour itself causing the stagnation of distal
secretions with subsequent infection
86. Differential diagnosis…/Radiologically
Empyema
Empyema is a purulent infection that in most cases is confined to the
pleural space, although it can develop as a complication, or be a
cause, of a lung abscess
If an empyema contains an air-fluid level, then a broncho-pleural
fistula is likely to be present
Often difficult to distinguish radiographically between a localized
empyema with a bronchopleural fistula and a lung abscess
89. Differential diagnosis…/Radiologically
CT may be helpful in doubtful cases
In abscess: wall is of varying thickness
with an irregular intraluminal margin and exterior surfaces
In empyema: wall is cavities tend to be smooth, separating the
thickened pleural layers with compressed lung beneath the
visceral layer
90. Differential diagnosis…/Radiologically
Infected bullae
Infected bulla is parenchymal
& Empyema is extra-parenchymal
both entities can demonstrate air-fluid levels
An infected bulla is pneumonia within a preexisting bullous cavity and does
not result from tissue necrosis
Patient with infected bulla is less ill than might be suggested by the chest
radiograph
91. Differential diagnosis…/Radiologically
Infected bullae….
There may be little evidence of consolidation in surrounding
lung when compared with an abscess
The margin of the bulla can often be seen to have a thin, smooth
wall on plain films or CT
An earlier CXR may assist in making this diagnosis
Infection within a bulla may cause its obliteration but this is
rare
92. Differential diagnosis…/Radiologically
Lung abscess Empyema Infected bullae
is a thick,
irregular walled
cavity
with no
associated lung
compression
lung usually is
characterized by
thin, smooth walls
with
compression of
uninvolved lung
usually is
characterized by thin,
smooth walls
with compression of
uninvolved lung
minimal surrounding
inflammation
93. Lung abscess Empyema
Fever, systemic complaints Purulent infection ,confined to pleural space
Purulent sputum Can developed as a complication, or be a cause, of a
lung abscess
WBC count >11*109/L If an empyema contains an air-fluid level, then a
broncho-pleural fistula is likely to be present
Response to antibiotic
therapy
Often difficult to distinguish radiographically between a
localized empyema with a bronchopleural fistula and a
lung abscess.
In CT - wall is of varying
thickness with an irregular
itraluminal margin and
exterior surface.
Seen on the lateral Chest X-ray as a D- shaped opacity
with the convexity projecting Anteriorly from the
Posterior Chest wall.
Differential diagnosis…/Radiologically
94. Infected bullae Necrosis in a lung tumour
Infected bulla is parenchymal
& Empyema is extra-parenchymal - both
entities can demonstrate air-fluid levels
An infected bulla is pneumonia within a
preexisting bullous cavity and does not result
from tissue necrosis
Patient with infected bulla is less ill than
might be suggested by the chest radiograph
There may be little evidence of
consolidation in surrounding lung when
compared with an abscess.
The margin of the bulla can often be seen to
have a thin, smooth wall on plain films or CT.
An earlier CXR may assist in making this
diagnosis.
Infection within a bulla may cause its
obliteration but this is rare
Age more >50 years,
No History suggestive of
Aspiration.
Lesion need not to be
situated in typically
dependent segment of lung.
In CXR – Eccentric cavity
with thick irregular walls.
Differentialdiagnosis…/Rad
iologically
97. Differential diagnosis…/Radiologically
Hiatus hernia
Diagnosis is suggested by ‘double cardiac shadow’ on the P/A
chest X-ray
and confirmed on the lateral view
by the typical appearance of a gastric air bubble behind the heart
often with a fluid level
Further diagnostic confirmation may be provided by a barium meal
or upper GI endoscopy if there is doubt
98. Infection within a lung cyst Hiatus hernia
Bronchogenic and other congenital Diagnosis is suggested by ‘double
cardiac shadow’ on the P/A chest
X-ray
foregut cysts may be impossible to Diagnosis is suggested by ‘double
cardiac shadow’ on the P/A chest
X-ray
differentiate from a lung abscess Diagnosis is suggested by ‘double
cardiac shadow’ on the P/A chest
X-ray
unless previous films are available
for comparison.
The diagnosis is made by the
position of the lesion (usually lower
lobe) and by retrograde
aortography.
Confirmed on the lateral view by the
typical appearance of a gastric air
bubble behind the heart often with a
fluid level
Similar difficulties may be posed by Further diagnostic confirmation may
99. A chest radiograph in a patient with a huge air-filled hiatal hernia,
which appears as a mediastinal mass.
Hiatal Hernia
106. Complications
Pleurisy
Massive haemoptysis
Spontaneous rupture into uninvolved lung segments
Failure of abscess cavity to resolve
Empyema - Rupture into pleural space causing
empyema
Bronchiectasis /
Pleural fibrosis
Trapped lung
30% of the time
Results from a bronchopleural fistula
109. Treatment
Principles:
Sputum is sent for C/S
& broad-spectrum antibiotic should be started
Postural drainage & chest physiotherapy
Surgery
Treatment of the cause if any
110. Treatment…
Antimicrobials
Currently the mainstay of therapy is antimicrobial therapy
Antibiotics should be given according to the culture & sensitivity
for prolonged period
Commonly sputum is sent for C/S and a broad-spectrum antibiotic
should be started
111. Treatment…
Modifications to treatment may be made according to response or in
light of culture and sensitivity (C/S) results
If improves, continue as above
If no response, antibiotic should be changed according to the C/S
report
112. Treatment…
The majority of patients are treated empirically
Most lung abscess pathogens are sensitive to conventional
antimicrobial therapy
Majority of lung abscesses are related to aspiration and are caused
by anaerobes
About 90% of patients with anaerobic lung abscess responds to
medical treatment
113. Treatment…
Clindamycin associated with fewer treatment failure & a shorter time to
symptom resolution than penicillin
May be preferable to other agents. Dose is 600 mg IV every 6-8
hourly
Switching to oral therapy at a dose of 300 mg every 6-8 hourly
when the patient improves
115. Treatment…
In hospitalized patients who have aspirated and developed a lung
abscess
Antibiotic therapy should include coverage against S aureus and
enterobacter and pseudomonas species
116. Treatment…
Pseudomonas aeruginosa infection is possible : prior antibiotic
use,
prolonged hospital course, or severe pneumonia
If P. aeruginosa infection is suspected, dual anti-Pseudomonas
therapy should be initiated with a Î’-lactam/aminoglycoside or a Î’-
lactam/quinolone combination
118. Treatments that may reduce chest exacerbations and/or improve lung
function in CF
119. Treatment…
Anaerobic lung infection
Clindamycin shown to be superior over parenteral penicillin
causes several anaerobes may produce B-lactamase & therefore
develop penicillin resistance
Although metronidazole is an effective drug against anaerobic
bacteria , a failure rate of 50% has been reported
120. Treatment…
Penicillin has a cure rate of 95%. It has activity against aerobic &
microaerophilic streptococcus
Metronidazole alone is not recommended as single-agent theapy
with 43% failure rate
121. Treatment…
Current recommendations are that
Patients are usually treated until the pulmonary infiltrates
have
resolved or the residual lesion is small and stable
122. Treatment…
Initially, antibiotics are given IV until the patient is afebrile &
shows clinical improvement (4-8 days)
Oral medications are then given, usually for a prolonged period
Oral therapy can be as effective as parenteral therapy
123. Treatment…
Duration of therapy
Although the duration of Antimicrobial therapy is not well
established
most clinicians generally prescribe antibiotic therapy for a total of
4-8 weeks
124. Patients with poor response to antibiotic
therapy
bronchial obstruction with a foreign body or neoplasm
infection with a resistant bacteria, mycobacteria, or fungi
Large cavity size ( > 6 cm in diameter) usually requires
prolonged therapy
125. Response to therapy
Patients with lung abscesses usually show clinical
improvement
with improvement of fever, within 3-4 days after initiating
the antibiotic therapy
Defervescence is expected in 7-10 days
Persistent fever beyond this time indicates therapeutic
failure / & these patients should undergo further diagnostic
studies to determine the cause of failure
127. Treatment…
On rare occasions, pus from a large abscess may flood into the
tracheobronchial tree
so that the rigid bronchoscopy is probably safer as it allows
adequate suctioning
128. Inpatient Care
For the following reasons, inpatient care is
advisable
initially in patients with lung abscess
Evaluation and management of patient's respiratory
status
Administration of intravenous antibiotics
Drainage of the abscess or empyema as needed
129. Outpatient Care
In patients who have small lung
abscess
who are not clinically ill
who are reliable
outpatient care may be
considered after obtaining
appropriate diagnostic studies such
as sputum culture, blood culture
etc.
Following initial intravenous
antibiotic therapy, the patient may
be treated on an outpatient basis
for completion of prolonged
therapy, which is often required
for cure
130. Surgical treatment
Surgery is very rarely required for patients with
uncomplicated lung abscesses
Approx. 10% of lung abscess require surgical intervention
131. Surgical treatment…
Usual indications for surgery
1.Patients who fail medical
therapy
2.Complications e.g.
a. Massive haemoptysis
b. Bronchopleural fistula
c.Empyema
.Suspected neoplasm
5.Congenital lung malformation
6.In the setting of fulminant
infection
132. Surgical treatment…
The surgical procedure performed is either lobectomy or
pneumonectomy
Tube thoracostomy in the case of empyema and
Lung resection(either lobectomy or pneumonectomy) in the case of
massive haemoptysis
133. Surgical treatment …
Sometimes, surgery (eg- lobectomy) may be done
The most frequent indication for thoracotomy and resection is the
suspicion that the abscess is a cavitating tumour
Lung resection is also occasionally necessary for massive and life-
threatening haemoptysis
134. Surgical treatment …
Drainage of an abscess is recommended when
Sepsis persists 5 to 7 days after the initiation of
antibiotic therapy
Abscess larger than 4 cm
Abscess increase in size while the patient is on medical
therapy
Rupture into pleural space causing empyema
In a patient with coexisting empyema and lung abscess
135. Response to therapy
In a study of 71 patients
13% of lung abscess cavities
had disappeared in 2 weeks
44% in 4 weeks
59% in 6 weeks
70% within 3 months after treatment with
appropriate antibiotics
There is residual chest radiographic shadowing
when extensive fibrosis has occurred
137. Chest physiotherapy
encouragement of cough & mobilization of secretions are
potentially useful intervention.
Adequate drainage of the lung abscess is an important part of
management.
An air-fluid level implies the
presence of a communication
from the abscess cavity to the tracheobronchial tree.
138. Chest physiotherapy…
Chest physiotherapy & postural drainage may be helpful in
helping
the patient to clear purulent material
and postural drainage can be applied with the affected pulmonary
segments uppermost
Significant pulmonary haemorrhage may occur
140. Prognosis
Lung abscess was a devastating disease in the pre antibiotic era
when one third of the patients died
another one third recovered
and the remainder developed debilitating illnesses such as recurrent
abscesses, chronic empyema, bronchiectasis, or other consequences
of chronic Pyogenic infections
141. Prognosis…
The prognosis for lung abscess following antibiotic treatment is
generally favorable
Over 90% of lung abscesses are cured with medical management
alone unless caused by bronchial obstruction secondary to
carcinoma
142. Prognosis…
Most patients with primary lung abscess improve
with
antibiotics with cure rates documented at 90-95%
Mortality between 5 and 10%
2.4% in community-acquired lung abscess &
66.7% in hospital-acquired lung abscess
143. Prognosis…
Recurrent aspiration
serious co-morbidity
Prolonged symptom
complex before presentation
Presence of thick-walled
cavities
cavity size (>6 cm)
Development of empyema
Advanced age
Abscess associated with an
obstructing lesion/
Neoplasm
Prognostic factors associated with failure of medical therapy
145. Prevention
Prevention of aspiration is important to minimize the risk of lung abscess
Vomiting patients should be placed on their sides
Improving oral hygiene and dental care in elderly and debilitated patients
Positioning the supine patient at a 30° reclined angle minimizes the risk of
aspiration
Early intubation in patients who have diminished ability to protect the
airway
from massive aspiration (cough, gag reflexes), should be considered