LUNG ABSCESS 97

8/7/2019 LUNG ABSCESS 97

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LUNG ABSCESSLUNG ABSCESS

MUSLIMAH BT MOHD HAMAMI



DEFINITIONDEFINITION

y necrosis of the pulmonary tissue and

formation of cavities containing necrotic

debris or fluid caused by microbial

infection.

y The formation of multiple small (<2 cm)

abscesses is occasionally referred to as

necrotizing pneumonia or lung gangrene.



CAUSESCAUSES

1. Aspiration of organisms from the mouth (mostcommon)

2. Complication of severe or incompletely treatedpneumonia (particularly staphylococci or

klebsiellae)3. Bronchial obstruction (CA of bronchus)

4. Pulmonary infarction

5. Septic pulmonary emboli (septicaemia, rightheart endocarditis, IV drug use)

6. Inhalation of foreign body

7. Extension of subphrenic or hepatic abscess

8. Penetrating pulmonary trauma, e.g. stab wound



PREDISPOSING FACTOR FORPREDISPOSING FACTOR FOR

ASPIRATIONASPIRATION1. Altered conciousness in : Stroke

cerebral palsy

Alcohol intoxication

Patient with anaesthesia, sedatives or opiods2. Poor host defences

Impair cough reflex

Poor glottic closure

Impaired mucociliary clearance3. Patient with poor oral hygiene or gingivitis

4. Choking

5. Oesophageal obstruction



CLASS ORGANISM

Anaerobic organisms ActinomycesBacteroidesClostridium

FusobacteriumPeptostreptococcusPrevotella

Aerobic organisms Burkholderia pseudomallei

Klebsiella pneumoniaNocardiaPseudomonas aeruginosaStaphylococcus aureusStreptococcus milleri Other streptococci

AETIOLOGYAETIOLOGY



CLASS ORGANISM

Fungi Aspergillus sp (aspergillosis)

Blastomycesdermatitidis (blastomycosis)Coccidioidesimmitis (coccidioidomycosis)Cryptococcusneoformans (cryptococcosis)

Histoplasmacapsulatum (histoplasmosis)Pneumocystis jiroveci Rhizomucor (mucormycosis)Rhizopus sp (mucormycosis)

Sporothrix schenckii (sporotrichosis)



CLASS ORGANISM

Mycobacteria M ycobacterium avium-cellulareM ycobacterium kansasii M ycobacterium tuberculosis

Parasites Entamoebahistolytica (amebiasis)Echinococcus

granulosus (echinococcosis)Echinococcusmultilocularis (echinococcosis)Paragonimuswestermani (paragonimiasis)



PATHOPHYSIOLOGYPATHOPHYSIOLOGY

Predisposing factors for aspiration

Aspiration of oral flora (especiallyanaerobes) Introduction of the pathogento the lung

Inflammation tissue necrosis abscess

formation

abscess usually ruptures into bronchus, andits contents are expectorated, leaving an airand fluid-filled cavity



CLINICAL FEATURESCLINICAL FEATURES

SYMPTOMS SIGNS

y Swinging fever

y Productive cough

y Purulent, foul-smelling

sputum

y

Pleuritic chest painy Haemoptysis

y Malaise

y Weight loss

y Temperature >38

y Finger clubbing

y Anaemia

y consolidation may be present

o decreased breath sounds

o dullness to percussion,

o bronchial breath sounds

o course inspiratory

crackles



COMPLICATIONCOMPLICATION

y Empyema

y pneumothorax

y Respiratory failure



DIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSIS

y Tuberculosis

y Pneumocystis carinii pneumonia

y Sarcoidosis

y Carcinoma of the lung

y Pulmonary embolism



INVESTIGATIONINVESTIGATION

LABAROTORY IMAGING

y FBC

Anaemia, neutrophilia

y ESR

y Blood culture

y Sputum microscopy, C&S

y Pus C&S (obtained bytranstracheal aspiration,bronchoscopy orpercutaneous transthoracicaspiration wt US or CTguidance

y CXR

Walled cavity, often with

air-fluid level

y CT scan

Exclude obstruction

y Bronchoscopy

Obtain diagnostic

specimen



A 54-year-old patient

developed cough with

foul-smelling sputum

production. A chest

radiograph shows

lung abscess in the

left lower lobe,

superior segment.



A lateral chest

radiograph shows

air-fluid level

characteristic of

lung abscess.



A 42-year-old man

developed fever andproduction of foul-

smelling sputum. He had

a history of heavy alcohol

use, and poor dentitionwas obvious on physical

examination.CT scan

shows a thin-walled

cavity with surrounding

consolidation.



TREATMENTTREATMENTy Clindamycin 600 mg IV q 6 to 8 h - against streptococci

and anaerobic organisms.

y The primary alternative is a combination -lactamaseinhibitor :

ampicillin/sulbactam 1 to 2 g IV q 6 h

ticarcillin/clavulanate 3 to 6 g IV q 6 h

piperacillin/tazobactam 3 g IV q 6 h

y Metronidazole 500 mg q 8 h may be used but must becombined with penicillin 2 million units q 6 h IV.

y Less seriously ill patients may be given oral antibioticssuch as

clindamycin 300 mg po q 6 h

amoxicillin/clavulanate 875/125 mg po q 12 h.y IV regimens can be converted to oral ones when the

patient defervesces.

y For very serious infections involving MSR A, the besttreatment is vancomycin or linezolid

.



TREATMENT (cont.)TREATMENT (cont.)

y Surgeryy If the patient is weak or paralyzed or has

respiratory failure, tracheostomy and suctioningmay be necessary.

y Percutaneous or surgical drainage of lungabscesses is necessary in patient who does notrespond to antibiotics

y When surgery is necessary: lobectomy is the most common procedure; segmental

resection for small lesions (< 6 cm diameter cavity). Pneumonectomy may be necessary for multiple

abscesses or for pulmonary gangrene unresponsive todrug therapy



THANK YOUTHANK YOU

LUNG ABSCESS 97

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