CT Chest: Lung abscess

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CT Chest: Lung abscess

  1. 1. Image Of The Week By Preethi Subramanian, Ist year, PG Prof. Dr.G. Elangovan’s Unit MM4
  2. 3. History: Patient presented with c/o Left sided pricking type of chest pain --7 days Fever & Breathlessness --4 days Chronic Alcoholic & Smoker . On Examination , Patient Febrile, Vitals Stable, RS: Decreased Breath Sounds on Left infraclavicular, infrascapular & infra axillary areas. VF/VR decreased in above areas .
  3. 8. <ul><li>Impression: </li></ul><ul><li>Loculated Effusion in anterior Chest wall On the </li></ul><ul><li>Left Side. </li></ul><ul><li>Effusion in fissure of Left lower Lobe. </li></ul><ul><li>Cavity with air – fluid level in left lower lobe. </li></ul>
  4. 9. Differential Diagnosis <ul><li>Carcinoma-SCC </li></ul><ul><li>Abscess-fungal/bacterial/TB </li></ul><ul><li>Vascular-septic emboli </li></ul><ul><li>Inflammatory-rheumatoid nodule </li></ul><ul><li>Young-bronchogenic cyst </li></ul><ul><li>Pulmonary Sequestration </li></ul><ul><li>Wegener’s Granulomatosis </li></ul><ul><li>Trauma-resolving contusion </li></ul>
  5. 10. THANK YOU
  6. 11. Medical Care Of Lung Abscess <ul><li>Antibiotic therapy: </li></ul><ul><li>Anaerobic lung infection: Clindamycin [150mg-300mg every 6hourly ] is now the standard therapy. </li></ul><ul><li>Although metronidazole is an effective drug against anaerobic bacteria, a failure rate of 50% has been reported. </li></ul>
  7. 12. <ul><li>In hospitalized patients who have aspirated and developed a lung abscess, antibiotic therapy should include coverage against S aureus and Enterobacter and Pseudomonas species. </li></ul><ul><li>Cefoxitin is a second-generation cephalosporin that has gram-positive, gram-negative, and anaerobic coverage. This agent may be used when a polymicrobial infection is suspected as cause of lung abscess. </li></ul>
  8. 13. <ul><li>Duration of therapy: </li></ul><ul><li>Most clinicians prescribe antibiotic therapy generally for 4-6 weeks. </li></ul><ul><li>Current recommendations are that antibiotic treatment should be continued until the chest radiograph has shown either the resolution of lung abscess or the presence of a small stable lesion. </li></ul>
  9. 14. <ul><li>Response to therapy: </li></ul><ul><li>Patients show clinical improvement, with improvement of fever, within 3-4 days after initiating the antibiotic therapy. </li></ul><ul><li>Patients with poor response to antibiotic therapy include bronchial obstruction with a foreign body or neoplasm or infection with a resistant bacteria, Mycobacteria, or fungi. </li></ul>
  10. 15. Surgical Care <ul><li>Surgery is very rarely required for patients with uncomplicated lung abscesses. The usual indications for surgery are failure to respond to medical management, suspected neoplasm, or congenital lung malformation. The surgical procedure performed is either lobectomy or pneumonectomy. </li></ul>
  11. 16. Prognosis <ul><li>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 . </li></ul><ul><li>  </li></ul>

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