Post on 15-Jan-2016
Lung Abscess
Sung Chul Hwang, M.D.
Dept. of Pulmonary and Critical Care Medicine
Ajou University School of Medicine
Definition
Infection of the lung parenchyme consisting of one or more necrotic inflammatory cavities, containing fibropurulent exudates and gaseous materials
Etiology of Lung Abscess
Aspiration : seizure, coma, surgery, DM, sedatives, alcohol, neurologic diseases
Bronchial obstruction : malignancy, F.B. Septic emboli : SBE, catheters, prostheses, p
elvic thrombophlebitis Direct Spread : subphrenic, hepatic Pneumonia complication : S. aureus, Klebsiell
a, pseudomonas, etc
Symptoms of Lung Abscess
Cough : 77% Sputum : 65% Fever and chills : 40% Chest pain : 24% Hemoptysis : 16% Dyspnea : 15% Anorexia : 4% Night sweats : 1 %
Most common cause Tosillectomy, seizure, neurosurgery, alcoholism, etc Organism identification in only 30-40% Mostly Anarobic, mixed organisms “Putrid sputa” Dependent portions: Lowerlobe,posteior & lateral bas
al seg. Upper lobe, posterior seg. Usually single abscess cavity
Aspiration Abscess
Necrotizing Pneumonia
Community :Staph. Aureus or Klebsiella Hospital : Pseudomonas or Proteus Aspiration pneumonias cause necrotizing infect
ions Klebsiella predominant in alcoholics or DM
Secondary to Malignancy
Bronchogenic cancer : Squamous Ca Lymphoma Leukemia Multiple Myeloma Metastatic Malignancies
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, Metronid
azole to cover for the Anarobes Postural drainage Bronchoscopic drainage
Indications for Surgery
Massive hemoptysis Refractory to Medical treatment Large cavity with thick walls Complicated by malignancy Empyema develops Chronicity, Recurrence Remaining residual cavity
Prognosis
Relatively Favorable Underlying Disease is
important Operation Rate : 15% Overall mortality rate : 10%
Empyema
Mainly Surgical disease Presence of Pus or demonstrable Micro-organi
sms such as, Bacteria, mycobacterium, or fungus in pleural cavity
Closed Drainage Pig-tail catheter insertion with intra-pleural uro
kinase instillation Surgical drainage with empymectomy : conven
tional surgery or VATS
Indication for Pneumococcal Vaccination (Polyvalent) >65 years Chronic Cardiac conditions Chronic Lung Diseases Asplenia Chronic Liver Diseases Alcoholism DM Chronic Renal Failure Hodgkin’s Disease Leukemia, Multiple myeloma Chronic hemodialysis HIV Infection