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

Classifications

Duration

Acute < 4-6 week

Chronic

Causes

Primary

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 %

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

Lung Abscess

Cavity with“Air-Fluid level”

Lung Abscess

Left Upper Lobe Posterior Segment

Lung Abscess

Pseudomonas Lung Abscess

Lung Abscess

Malignant Abcess Cavity

Septic Pneumonia

multiplr

Multiple Bilateral Septic Emboli

Septic Emboli

Septic Emboli in Pulmonary arteries : H & E

Empyema

Empyema

Empyema

diaphragm

pus

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