Download - 1 lung abscess(lh)
PULMONARY ABSCESS
Huai Liao Pulmonary department, the 1st affiliated hospital of Sun Yat-sen university
Backgrounds
A necrotizing parenchymal lung infection generally caused by aspiration
Clincal fectures: high fever, sputum
Radiograph: cavity>2cmMobidity: male>female Incidence:↓
Etiology
Organisms: the flora of upper respiratory
tract, ~ 90% anaerobicOut of hospital: anaerobes colonized the
mouth, pneumococci, staphylococci, enteric gram negatives (in elderly)
In hospital: both anaerobes and aerobes, usually S aureus and enteric gram negative bacilli
Categories
Aspiratory lung abscessSecondary lung abscessHematogenous lung abscess
Aspiratory lung abscess
Predisposing Conditions– Unconscious state– Aspiration of a Large Bacterial Inoculums– Loss of Cough Refle– …
Common Segments
Gravitational forces and position of the patient determine the site
1) sitting position –RLL
2) supine position –RLL
3) right lateral decubitus position --RUL
Bacteriology
Common pathogens
1) gram positive anaerobes -- peptococci and peptostreptococci
2) gram negative anaerobes
Secondary abscess
Secondary to preexisting conditionsBronchial cysts, carcinoma, TB cavityFood and foreign bodyThe lesion of adjacent organ
– Subphrenic abscess– Perinephric abscess– Amebic as abscess of the liver
Secondary abscess
Hematogenous lung abscess
Extrapulmonary infections Via bloodstreamRadiographPathogen: staphylococcus aureus,
stapphylococcus epidermidis, or streptococcus
Hematogenous lung abscess
Common Segment--multiple,in fringe of lung
Common pathogens--staphylococcus aureus
Pathology
The abscess is characterized by destruction of lung tissue forming a cavity
The cavity is filled with pus (necrotic debris/liquid) or pus and gas (air)
The abscess(s) may occur in any part of the lung
Pathology (Early)
begin as local infections
Pathology (Later)
suppuration and necrosisCavity with fluid level forms
Pathology (Later)
Pyopneumothorax or empyema
Chronic lung abscessAngioma: haemoptysis
Clinical Picture
1. Acute onset2. High fever, chills, productive cough with
sputum, chest pain, anorexia, malaise, 3. Coughing up a large amount of pus4. Haemoptysis (1/3)5. Pleuritic pain, dyspnea6. Chronic abscess: persistent symptoms, Weight
loss and anemia7. Hermatogenous abscess: primary infection,
pyemia, followed by a cough, rarely haemoptysis
Clinical Picture
Physical finding Early phases: those of pneumonia, with
or without a pleural effusion Later stage: amphoric or cavernous
breath sounds, pleural effusions, empyema
Laboratory examination
Blood Rt: WBC↑ , N%↑; anemia Sputum Gram Stain Bacterial cultures: Bronchoscopy Fine Needle Aspiration Bronchoscopy: Diagnosis Specimen Collection Drainage of Pus
Laboratory examination
Chest radiograph
--a parenchymal infiltrate with a cavity containing an air-fluid level
Bronchoscopy
Diagnostic value: Exclude carcinoma and
foreign bodyCollect specimenTherapeutic value
Diagnosis
Symptoms, sign, and Roentgenographic finding
differentiate from:
1)pneumonia
2)lung cancer
3)pulmonary tuberculosis
4)infected cyst
Differential diagnosis
Pneumonia– Chest X-ray: infiltration without cavity– Short course
Pulmonary TB– Sputum smear for TB bacilli– bronchoscopy
Differential diagnosis
Bronchial carcinoma– Obstructive pneumonia– Cavitated bronchial carcinoma
Infected lung cyst– Chest X-ray: thin walled, prior radiograph
Treatment
Antibiotic1.Antibiotic of Choice : 1) Penicillin 2) Metronidazole 3) Clindamycin 4) Others2.The expected response: decrease fever within 3~7d, elimination of fever within
7~14d, resolves the putrid odor of the sputum within 3~10d.
3.Prolonged treatment 8~12 weeks
Treatment
Methods of Drainage
1) Postural Drainage
2) Percussion on back
3) BronchoscopyRole of Surgery
– Chonic abscess– Massive haemoptysis
Prevention
Risk factorsEarly treatmentAdequate course