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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.
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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, pelvic thrombophlebitis • Direct Spread : subphrenic, hepatic • Pneumonia complication : S. aureus, Klebsiella, pseudomonas, etc
Duration Acute < 4-6 week Chronic Causes Primary Secondary Classifications
Symptoms of Lung Abscess • Cough : 77% • Sputum : 65% • Fever and chills : 40% • Chest pain : 24% • Hemoptysis : 16% • Dyspnea : 15% • Anorexia : 4% • Night sweats : 1 %
Aspiration Abscess • 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 basal seg. Upper lobe, posterior seg. • Usually single abscess cavity
Necrotizing Pneumonia • Community :Staph. Aureus or Klebsiella • Hospital : Pseudomonas or Proteus • Aspiration pneumonias cause necrotizing infections • 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, Metronidazole 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-organisms such as, Bacteria, mycobacterium, or fungus in pleural cavity • Closed Drainage • Pig-tail catheter insertion with intra-pleural urokinase instillation • Surgical drainage with empymectomy : conventional surgery or VATS
Lung Abscess Cavity with “Air-Fluid level”
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Septic Pneumonia Multiple Bilateral Septic Emboli multiplr
Septic Emboli Septic Emboli in Pulmonary arteries : H & E
Empyema pus diaphragm
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