LUNG ABSCESS

SITI SAJARIAH MUNIP,dr.SpP

RSI AISYIYAH MALANG
Fk umm; Nopember 2015
 Definition
• Infection of the lung parenchyme
consisting of one or more necrotic
inflammatory cavities, containing
fibropurulent exudates and gaseous
materials
 Lung Abscess

EDA
PM

AFC C

RB

A
Figure 16-1. Lung abscess. A, Cross-sectional view of lung abscess. AFC, Air-fluid cavity;
RB, ruptured bronchus (and drainage of the liquified contents of the cavity); EDA, early development of
abscess; PM, pyogenic membrane. Consolidation (B) and excessive bronchial secretions (C) are common
secondary anatomic alterations of the lungs.
 Etiology of Lung Abscess
• Aspiration : seizure, coma, surgery, DM, sedatives, alcohol,
neurologic diseases
• Bronchial obstruction : malignancy, F.B.
• Septic emboli : SBE, catheters, prostheses, pelvic
thrombophlebitis
• Direct Spread : subphrenic, hepatic
• Pneumonia complication : S. aureus, Klebsiella, pseudomonas, etc
• Vascular obstruction
• Interstitial lung disease
• Bullae or cysts
• Penetrating chest wounds
 Classifications

• Duration • Causes

• Acute < 4-6 week

• Primary

• Chronic • Secondary
Symptoms of Lung Abscess

• Cough : 77%
• Sputum : 65%
• Fever and chills : 40%
• Chest pain : 24%
• Hemoptysis : 16%
• Dyspnea : 15%
• Anorexia : 4%
• Night sweats : 1 %
 Clinical Data Obtained at the
Patient’s Bedside

Vital signs
Increased respiratory rate
Increased heart rate, cardiac
output, blood pressure
 Clinical Data Obtained at the Patient’s
Bedside
• Chest pain/decreased chest expansion
• Cyanosis
• Cough, sputum production, and hemoptysis
• Chest assessment findings
– Increased tactile and vocal fremitus
– Dull percussion note
– Bronchial breath sounds
– Diminished breath sounds
– Whispered pectoriloquy
– Pleural friction rub
Figure 2-11. A short, dull, or flat percussion note is typically produced over areas of alveolar
consolidation.
Figure 2-16. Auscultation of bronchial breath sounds over a consolidated lung unit.
Figure 2-19. Whispered voice sounds auscultated over a normal lung
are usually faint and unintelligible.
 Abnormal Laboratory Tests
and Procedures
Sputum examination
• Gram-positive organism
– Streptococcus
• Anaerobic organisms
– Peptococcus
– Peptostreptococcus
– Bacteroides
– Fusobacterium
 Radiologic Findings
Chest radiograph
• Increased density
• Cavity formation
• Cavity with air-fluid levels
• Fibrosis
• Pleural effusion
Figure 16-2. Reactivation tuberculosis with a large cavitary lesion containing an air-fluid level in the right lower
lobe. Smaller cavitary lesions are seen in other lobes. (From Armstrong P et al: Imaging of diseases of the
chest, ed 2, St. Louis, 1995, Mosby.)
 Diagnosis
• X-ray : Cavity with “air-fluid level”
• CBC : leukocytosis, Anemia , etc
• Cultures : Sputum & Blood
• Anaerobic culture is important
• Chest CT
• Sputum cytology
• Sputum AFB
• Bronchoscopy or NAB to Rule out malignancy
 Treatment
• Medical treatment is the mainstay
• Pennicillin, Cephalosporin
• Clindamycin, chloramphenicol,
Metronidazole to cover for the Anarobes
• Postural drainage
• Bronchoscopic drainage
 Prognosis
• Relatively Favorable
• Underlying Disease is important
• Operation Rate : 15%
• Overall mortality rate : 10%
 Indications for Surgery
• Massive hemoptysis
• Refractory to Medical treatment
• Large cavity with thick walls
• Complicated by malignancy
• Empyema develops
• Chronicity, Recurrence
• Remaining residual cavity
THANK FOR YOUR ATTENTION