Lung Abscess Presentation

Copyright © 2006 by Mosby, Inc.Slide 1

Chapter 16Chapter 16 Lung Abscess Lung Abscess

Figure 16-1. Lung abscess. A, Cross-sectional view of lung abscess. Figure 16-1. Lung abscess. A, Cross-sectional view of lung abscess. AFC,AFC, Air-fluid cavity; Air-fluid cavity;RB,RB, ruptured bronchus (and drainage of the liquified contents of the cavity); ruptured bronchus (and drainage of the liquified contents of the cavity); EDA,EDA, early early

development of abscess; development of abscess; PM,PM, pyogenic membrane. Consolidation (B) and excessive bronchial pyogenic membrane. Consolidation (B) and excessive bronchial secretions (C) are common secondary anatomic alterations of the lungs.secretions (C) are common secondary anatomic alterations of the lungs.

A

AFC

RB

EDAPM

B

C


Anatomic Alterations of the LungsAnatomic Alterations of the Lungs

Alveolar consolidationAlveolar consolidation

Alveolar-capillary and bronchial wall destructionAlveolar-capillary and bronchial wall destruction

Tissue necrosisTissue necrosis

Cavity formationCavity formation

Fibrosis and calcification of the lung parenchymaFibrosis and calcification of the lung parenchyma

Bronchopleural fistulaeBronchopleural fistulae

AtelectasisAtelectasis

Excessive airway secretions and empyemaExcessive airway secretions and empyema


EtiologyEtiology

Pneumonia caused by aspiration (most common)Pneumonia caused by aspiration (most common) KlebsiellaKlebsiella

StaphylococcusStaphylococcus

Predisposing factors for aspirationPredisposing factors for aspiration Alcohol abuseAlcohol abuse

Seizure disordersSeizure disorders

General anesthesiaGeneral anesthesia

Head traumaHead trauma

Cerebrovascular accidentCerebrovascular accident

Swallowing disordersSwallowing disorders


EtiologyEtiology

(Less frequent causes)(Less frequent causes)

Aerobic organisms Aerobic organisms Streptococcus pyogenesStreptococcus pyogenes

Klebsiella pneumoniaeKlebsiella pneumoniae

Escherichia coliEscherichia coli

On rare occasionsOn rare occasions Streptococcus pneumoniaeStreptococcus pneumoniae

Pseudomonas aeruginosaPseudomonas aeruginosa

Legionella pneumophilaLegionella pneumophila


EtiologyEtiology

(Other organisms that may lead to a lung abscess)(Other organisms that may lead to a lung abscess)

Mycobacterium tuberculosisMycobacterium tuberculosis

Fungal organismsFungal organisms Histoplasma capsulatumHistoplasma capsulatum

Coccidioides immitisCoccidioides immitis

BlastomycesBlastomyces

Aspergillus fumigatusAspergillus fumigatus

ParasitesParasites Paragonimus westermaniParagonimus westermani

EchinococcusEchinococcus

Entamoeba histolyticaEntamoeba histolytica


EtiologyEtiology

Lung abscess may also develop from:Lung abscess may also develop from:

Bronchial obstructionBronchial obstruction

Vascular obstructionVascular obstruction

Interstitial lung diseaseInterstitial lung disease

Bullae or cystsBullae or cysts

Penetrating chest woundsPenetrating chest wounds


Overview of the Cardiopulmonary Overview of the Cardiopulmonary Clinical Manifestations Associated Clinical Manifestations Associated

with LUNG ABSCESSwith LUNG ABSCESS

The following clinical manifestations result from The following clinical manifestations result from the pathophysiologic mechanisms caused the pathophysiologic mechanisms caused (or activated) by (or activated) by Alveolar ConsolidationAlveolar Consolidation (see (see Figure 9-8)Figure 9-8), , and when the abscess is draining, and when the abscess is draining, by by Excessive Bronchial SecretionsExcessive Bronchial Secretions (see (see Figure 9-8)—the major anatomic alterations of Figure 9-8)—the major anatomic alterations of the lungs associated with chronic bronchitis the lungs associated with chronic bronchitis (see Figure 16-1). (see Figure 16-1).


Clinical Data Obtained at theClinical Data Obtained at the Patient’s Bedside Patient’s Bedside

Vital signsVital signs

Increased respiratory rateIncreased respiratory rate

Increased heart rate, cardiac output, Increased heart rate, cardiac output, blood pressureblood pressure


Clinical Data Obtained at the Clinical Data Obtained at the Patient’s BedsidePatient’s Bedside

Chest pain/decreased chest expansionChest pain/decreased chest expansion

CyanosisCyanosis

Cough, sputum production, and hemoptysisCough, sputum production, and hemoptysis

Chest assessment findingsChest assessment findings Increased tactile and vocal fremitusIncreased tactile and vocal fremitus

Dull percussion noteDull percussion note

Bronchial breath soundsBronchial breath sounds

Diminished breath soundsDiminished breath sounds

Whispered pectoriloquyWhispered pectoriloquy

Pleural friction rubPleural friction rub


Figure 2-11. Figure 2-11. A short, dull, or flat percussion note is typically produced over areas A short, dull, or flat percussion note is typically produced over areas of alveolar consolidation.of alveolar consolidation.


Figure 2-16. Figure 2-16. Auscultation of bronchial breath sounds over a consolidated lung Auscultation of bronchial breath sounds over a consolidated lung unit.unit.


Figure 2-19. Figure 2-19. Whispered voice sounds auscultated over a normal lungWhispered voice sounds auscultated over a normal lungare usually faint and unintelligible.are usually faint and unintelligible.


Clinical Data Obtained from Clinical Data Obtained from Laboratory Tests and Special Laboratory Tests and Special

ProceduresProcedures


Pulmonary Function Study: Pulmonary Function Study: Expiratory Maneuver FindingsExpiratory Maneuver Findings

FVC FEVT FEF25%-75% FEF200-1200

N or N or N

PEFR MVV FEF50% FEV1%

N N or N N or

FVC FEVT FEF25%-75% FEF200-1200

N or N or N

PEFR MVV FEF50% FEV1%

N N or N N or


Pulmonary Function Study: Pulmonary Function Study: Lung Volume and Capacity Findings Lung Volume and Capacity Findings

VT RV FRC TLC

N or

VC IC ERV RV/TLC%

N

VT RV FRC TLC

N or

VC IC ERV RV/TLC%

N


Arterial Blood GasesArterial Blood Gases

Mild to Moderate Lung AbscessMild to Moderate Lung Abscess

Acute alveolar hyperventilation with Acute alveolar hyperventilation with hypoxemiahypoxemia

pH PaCO2 HCO3- PaO2

(Slightly)

pH PaCO2 HCO3- PaO2

(Slightly)


Time and Progression of Disease Time and Progression of Disease

100100

5050

3030

80

0

PaCO2

1010

2020

4040

Alveolar HyperventilationAlveolar Hyperventilation

6060

7070

9090 Point at which PaO2 declines enough to stimulate peripheral oxygen receptors

Point at which PaO2 declines enough to stimulate peripheral oxygen receptors

PaO2

Disease OnsetDisease OnsetP

aO2

or

PaC

O2

PaO

2 o

r P

aCO

2

Figure 4-2. PaO2 and PaC02 trends during acute alveolar hyperventilation.


Arterial Blood GasesArterial Blood Gases

Severe Lung AbscessSevere Lung Abscess

Acute ventilatory failure with hypoxemiaAcute ventilatory failure with hypoxemia

pH PaCO2 HCO3- PaO2

(Slightly)

pH PaCO2 HCO3- PaO2

(Slightly)


Time and Progression of DiseaseTime and Progression of Disease

100100

5050

3030

80

0

PaO2

1010

2020

4040

Alveolar HyperventilationAlveolar Hyperventilation

6060

7070

9090Point at which PaO2 declines enough to stimulate peripheral oxygen receptors

Point at which PaO2 declines enough to stimulate peripheral oxygen receptors

PaCO 2

Acute Ventilatory Failure Acute Ventilatory FailureDisease OnsetDisease Onset

Point at which disease becomes severe and patient begins to become fatigued

Point at which disease becomes severe and patient begins to become fatigued

Pa0

2 o

r P

aC0 2

Pa0

2 o

r P

aC0 2

Figure 4-7. PaO2 and PaCO2 trends during acute ventilatory failure.


Oxygenation IndicesOxygenation Indices

QS/QT DO2 VO2 C(a-v)O2

Normal Normal

O2ER SvO2

QS/QT DO2 VO2 C(a-v)O2

Normal Normal

O2ER SvO2


Abnormal Laboratory TestsAbnormal Laboratory Testsand Proceduresand Procedures

Sputum examinationSputum examination

Gram-positive organismGram-positive organism StreptococcusStreptococcus

Anaerobic organismsAnaerobic organisms PeptococcusPeptococcus

PeptostreptococcusPeptostreptococcus

BacteroidesBacteroides

FusobacteriumFusobacterium


Radiologic FindingsRadiologic Findings

Chest radiographChest radiograph

Increased density Increased density

Cavity formationCavity formation

Cavity with air-fluid levelsCavity with air-fluid levels

FibrosisFibrosis

Pleural effusionPleural effusion


Figure 16-2. Reactivation tuberculosis with a large cavitary lesion containing an air-fluid level in 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: the right lower lobe. Smaller cavitary lesions are seen in other lobes. (From Armstrong P et al:

Imaging of diseases of the chest,Imaging of diseases of the chest, ed 2, St. Louis, 1995, Mosby.) ed 2, St. Louis, 1995, Mosby.)


General Management of General Management of Lung AbscessLung Abscess

Respiratory care treatment protocolsRespiratory care treatment protocols

Oxygen therapy protocolOxygen therapy protocol

Bronchopulmonary hygiene therapy protocolBronchopulmonary hygiene therapy protocol

Hyperinflation therapy protocolHyperinflation therapy protocol


General Management of General Management of Lung AbscessLung Abscess

Medications and procedures commonlyMedications and procedures commonlyprescribed by the physicianprescribed by the physician

AntibioticsAntibiotics

SurgerySurgery


Classroom DiscussionClassroom DiscussionCase Study: Lung AbscessCase Study: Lung Abscess

Lung Abscess Presentation

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