CT Chest: Lung abscess

16
Image Of The Week By Preethi Subramanian, Ist year, PG Prof. Dr.G. Elangovan’s Unit MM4

Transcript of CT Chest: Lung abscess

Page 1: CT Chest: Lung abscess

Image Of The Week

ByPreethi Subramanian,

Ist year, PGProf. Dr.G. Elangovan’s Unit

MM4

Page 2: CT Chest: Lung abscess
Page 3: CT Chest: Lung abscess

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.

Page 4: CT Chest: Lung abscess
Page 5: CT Chest: Lung abscess
Page 6: CT Chest: Lung abscess
Page 7: CT Chest: Lung abscess
Page 8: CT Chest: Lung abscess

Impression:

Loculated Effusion in anterior Chest wall On the

Left Side.

Effusion in fissure of Left lower Lobe.

Cavity with air – fluid level in left lower lobe.

Page 9: CT Chest: Lung abscess

Differential Diagnosis

• Carcinoma-SCC• Abscess-fungal/bacterial/TB• Vascular-septic emboli• Inflammatory-rheumatoid nodule• Young-bronchogenic cyst• Pulmonary Sequestration• Wegener’s Granulomatosis• Trauma-resolving contusion

Page 10: CT Chest: Lung abscess
Page 11: CT Chest: Lung abscess

Medical Care Of Lung Abscess

Antibiotic therapy: Anaerobic lung infection: Clindamycin [150mg-

300mg every 6hourly ] is now the standard therapy.

Although metronidazole is an effective drug against anaerobic bacteria, a failure rate of 50% has been reported.

Page 12: CT Chest: Lung abscess

In hospitalized patients who have aspirated and developed a lung abscess, antibiotic therapy should include coverage against S aureus and Enterobacter and Pseudomonas species.

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.

Page 13: CT Chest: Lung abscess

Duration of therapy: Most clinicians prescribe antibiotic therapy generally

for 4-6 weeks.

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.

Page 14: CT Chest: Lung abscess

Response to therapy:

Patients show clinical improvement, with

improvement of fever, within 3-4 days after initiating the antibiotic therapy.

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.

Page 15: CT Chest: Lung abscess

Surgical Care

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.

Page 16: CT Chest: Lung abscess

Prognosis

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.