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LUNG ABSCESS
Ida Mujahidah Nur Ahmad Tabri

LUNG ABSCESS
Introduction
Etiology

Pathophysiology
Clinical Manifestation Workup Diagnosis Differential Diagnosis

Therapy
Preventive Prognosis

I. INTRODUCTION

Lung Abscess Lung abscess is a cavity in the lung tissue containing purulent material containing inflammatory cells from necrotic lung parenchyma due to the process of infection

When the cavity diameter> 2 cm and polynomial (multiple small abscesses) called necrotizing pneumonia

Large or small abscess have different clinical manifestations, but have the same predisposition and the same principle of differential diagnosis anyway.

I. INTRODUCTION
aspiration of infected objects

ABCESS
High virulence
decrease in the body's defense mechanism

I. INTRODUCTION

Elderly Men > women with ratio 3,5 :1

Urban areas with prevalence of alcoholism who reported high at age 41 years

LUNG ABSCESS
Introduction
Etiology Pathophysiology Clinical Manifestation Workup Diagnosis Differential Diagnosis

Therapy
Preventif Prognosis

II. ETIOLOGY

abscess expansion to subdiafragma complications of pneumonia Traumatic lung injury infection through the airway Lung infection

II. ETIOLOGY

Anaerob bacteria Aerob bacteria

Mycoobacteria

microorganisms that cause lung abscess

Fungi

Parasite, amoeba

LUNG ABSCESS
Introduction
Etiology Pathophysiology Clinical Manifestation Workup Diagnosis Differential Diagnosis

Therapy
Preventif Prognosis

III. PATHOPHYSIOLOGI

ASPIRATION

LUNG ABSCESS
HEMATOGEN

III. PATHOPHYSIOLOGI
commensal bacteria in the upper respiratory tract took into the lower respiratory tract

1
Aspiration

2
3

Due to recurrent aspiration, aspiration can not be removed and resulting in decreased in airway defense cause inflammation
Inflammatory process starts from the bronchi or bronchioles, spread to the lung parenchyma is then surrounded by granulation tissue

Extension to the pleura or relationship with bronchi often occurs that pus or necrotic tissue can be removed

III. PATHOPHYSIOLOGI

septicemia or as a septic emboli phenomenon

HEMATOGEN
B

secondary of focus of infection from other parts of the body such as tricuspid valve endocarditis

Hematogenous spread generally will form multiple abscesses and is usually caused by staphylococcal

III. PATHOPHYSIOLOGI

Lung abscess in the right lobe of the lung and pleural cavity

When rupture and penetrate to the diaphragm

Bacterial Liver Abscess Amoebic Liver Abscess

LUNG ABSCESS
Introduction
Etiology Pathophysiology Clinical Manifestation Workup Diagnosis Differential Diagnosis

Therapy
Preventif Prognosis

IV. Clinical Manifestation

intermitent febris cough with phlegm Malaise, weight loss night sweats Usually patients with lung abscess came after 2 weeks

Sputum

after the cavity, then smelling sputum is a typical sign. Sputum shaped greenish yellow pus, sometimes accompanied by blood. Respiratory patients also smells

IV. Clinical Manifestation Sputum

with blood (22%) Chest pain (37,1%) Anorexia (18%)

Cough with pleghm (55,6%)

Takayanagi dkk

Malaise (12,2%)

Fever (81,5%)
Asymptoma tic (2%)

Weight loss (8,3%)

IV. CLINICAL MANIFESTATION

On physical examination, initial clinical picture is similar to pneumonia

Signs of consolidation such as bronchial sound with wet rales or crackles in the abscess

dull to percussion

signs of pleural effusion

Sometimes symptoms of finger clubbing was found

LUNG ABSCESS
Introduction
Etiology Pathophysiology Clinical Manifestation Workup Diagnosis Differential Diagnosis

Therapy
Preventif Prognosis

V. WORKUP
Microorganisms cause abscesses was found from transtrakeal aspiration, transthoracic, or bronchial washings

Leukocytosis, especially PMN BSR can

Lab

For examination aerobic and anaerobic bacteria

Blood and sputum cultures

Mucus

But some clinician said that culture resistance of anaerob bacteria in the smell lung abscess is not necessary because is rather difficult and expensive

V. WORKUP

Typical: irregular cavity with air-fluid level

Often the posterior segment of the upper lobe or lower lobe superior
Abscesses may extend to the pleural surface forming an acute angle with the surface of the pleura

V. WORKUP

CT Scan

Visualization of anatomy better than chest X-ray Identify abscess or empyema accompanied pulmonary infarction
Abscesses appear as round radiolucent lesion with thick walls and irregular boundaries

Can show the location of the abscess in lung parenchyma and distinguishing with empyema

V. WORKUP

Multiple right lobe 3,9%

Right middle lobe 3,4%

Bilateral 8%

Takayanagi

Multiple left lobe 2%

Right lower lobe 15,6% Left lower lobe13,1%

Right upper lobe 35,1% Left lower lobe 19%

LUNG ABSCESS
Introduction
Etiology Pathophysiology Clinical Manifestation Workup Diagnosis Differential Diagnosis

Therapy
Preventif Prognosis

VI. DIAGNOSIS

anamnesis and physical examination

lesion cavity round with air-fluid level on CXR

microbes found In the analysis of sputum

DIAGNOSIS

LUNG ABSCESS
Introduction
Etiology Pathophysiology Clinical Manifestation Workup Diagnosis Differential Diagnosis

Therapy
Preventif Prognosis

VII. Differential Diagnosis

Infected bullae
Infected Lung cysts

Lung Abscess DD
Lung Hematom

Tuberculosis or Fungi infection

bronchogenic carcinoma with cavitation

Pneumoconiosis with cavitation

LUNG ABSCESS
Introduction
Etiology Pathophysiology Clinical Manifestation Workup Diagnosis Differential Diagnosis

Therapy
Preventif Prognosis

VIII. Therapy

Causing microbes

Empirical

Underlying disease

Until now there is no specific recommendation from the respiration medical association about complete therapeutic on pulmonary abscess

VIII. Therapy

Anaerob& Aerob infection

Clindamycin 600 mg IV q8h followed by 150-300 mg qid

aerob bacteria

-laktam/ -laktamase inhibitor, cephalosporin , fluoroquinolon

VIII. Therapy

comparing ampicillin + Sulbactam vs. Clindamisin cephalosporin obtained both well tolerated and effective

moxifloksasin 400 mg qd orally 4- 8 weeks were given to patients after standard initial therapy (ampicillinsulbactam, clindamisin, ceftriaxone, and levofloxacin) obtain clinical and radiological improvement, and found no relapse

VIII. Therapy

Medical treatment is usually given in the long term, ranging from 1-3 months

usually unsuccessful, in patients with poor prognostic factors

Abscess > 6 cm

Imuno compro mised

Malig nancy

Elderly

Unconsci ousness

Aerob pathogen bacteria infection

VIII. Therapy

Physiotherapy

Sputum drainage

Postural drainage

Long-term systemic antibiotic therapy is generally successful and does not require interventional procedures
Drainage is needed in approximately 11-21% of cases that fail with medical therapy

VIII. Therapy

CT-guided percutaneous drainage should be considered as an initial treatment option in patients who failed to medikamentosa

The success of lung abscess drainage with CT guidance was 90%,

If it is not possible to do percutaneous drainage with CT guidance, the actions that can be done is endoscopic drainage

VIII. Therapy

Endoscopic drainage

first reported in 1954. In the study performed by Felix Herth

catheter is inserted through the nose using flexible bronchoscopy, then sprayed gentamicin 80 mg in 20ml NaCl twice a day in abscess cavity

VIII. Therapy

Dekel Shlomi et al
Endobrakial catheter, carried an average of 4-6 days. Use is relatively safe and effective in patients with abscesses located near the main airway

Surgical Therapy
rarely performed on uncomplicated lung abscesses. Surgical form is a resection surgery with lobectomy or pneumektomi on multiple abscesses

VIII. Therapy

LUNG ABSCESS
Introduction
Etiology Pathophysiology Clinical Manifestation Workup Diagnosis Differential Diagnosis

Therapy
Preventif Prognosis

IX. Preventif Improve lifestyle Maintain oral health Patients with chronic diseases, avoid the occurrence of aspiration, malnutrition, and increase immunity status Patients with decreased consciousness, aspiration prevented with frequent secret sucking In conscious patient, respiratory physiotherapy and exercise of cough reflex are done Avoiding the use of general anesthesia in tonsillectomy

LUNG ABSCESS
Introduction
Etiology Pathophysiology Clinical Manifestation Workup Diagnosis Differential Diagnosis

Therapy
Preventif Prognosis

X. Prognosis

1936

Mortality 32-34%
antibiotics have not been be used 1935-1945

Cure rate can be reached 90-95% Mortality currently on 5% antibiotic era complete recovery In Lung abscess

Smith: essentially no impact in the use of sulfonamides

Risk Factors that worsen prognosis

Elderly Malnutrition

Malignancy
Immunocompromised

Duration of the abscess Abscess size Abscess location

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