Lung Abscess: Causes, Symptoms, and Treatment

2. Definition • A lung abscess is a localized necrotic lesion of the lung parenchyma containing purulent material that collapses and forms a cavity.

4. Classification • Duration of symptoms prior to diagnosis; • acute < 1month, • chronic > 1 month • Primary lung abscess or Secondary lung abscess; • Primary lung abscess: • used when abscess develops in individuals prone to aspiration or in general good health • Secondary lung abscess: obstructive airway neoplasm as a complication of intrathoracic surgery or systemic condition/treatment that compromises host immune defense mechanisms

5. Causes • Complication of bacterial pneumonia • Mechanical or function obstruction of bronchi by tumor • Foreign body • Bronchial stenosis • TB • Pulmonary embolism • Chest trauma

6. Risk factors • Impaired cough reflex • Patient who Cannot close glottis • Swallowing difficulties leading aspiration • Drug addiction • Alcoholism • Esophageal disorders • Compromised immune function • Patients without teeth and those receiving NG tube feeding • Patient with altered state of consciousness

7. Pathophysiology • Most occur as a complication of aspiration pneumonia and are poly microbial due to anaerobic bacteria Initial aspiration lung insult may be due to direct chemical injury from aspirated stomach acid or to areas of obstruction due to aspirated particulate matter (i.e. food • Secondary bacterial infection then may occur.

8. Initially cavity in the lung may or may not extend directly into a bronchus • Eventually abscess becomes surrounded or encapsulated by a wall of fibrous tissue • The necrotic process may extend until it reaches the lumen of a bronchus or pleural space and establishes communication with respiratory tract , plueral space

9. If bronchus is involved the purulent continuously are expectorated in the form of sputum • If pleura is involved an empyema results

10. Clinical features Symptoms • The onset may be abrupt or gradual. • Symptoms include fever, sweating, cough and chest pain • The cough is often non productive at first or may produce mucoid or mucopurulent expectorate from bronchial inflammation close to the abscess area and sometimes there is blood streaking.

11. There is an expectoration of foul-smelling brown or gray sputum (in anaerobic organisms) or green or yellow sputum • If this happens suddenly in large quantities, this denotes a rupture of the abscess cavity into the bronchus and blood streaking is common. • Pleuritic chest pain, especially with coughing is common • Weight loss, anaemia, and clubbing appear when the abscess becomes chronic

12. Signs • May be minimal. Consolidation due to pneumonia surrounding the abscess is the most frequent finding. • Inspiratoryrales and pleural rub may be heard. • Rupture into the pleural space produces signs of effusion or hydro pneumothorax. • Digital clubbing may develop rapidly.

13. Diagnosis Chest x ray • Transtracheal aspirate • Blood culture Pleural fluid (if empyema present) Transthoracic pulmonary aspirate CT scan   Flexible fiberopticbronchoscopy is performed to exclude bronchogenic carcinoma whenever bronchial obstruction is suspected.

14. CXR

15. Bronchoscopy

16. Laboratory Studies complete white blood cell count with differential may reveal leukocytosis. Gram stain, culture, and sensitivity. Routine investigations: e.g blood glucose , liver functions tests , renal functions test, electrolytes

17. Complications of lung abscess • Rupture into pleural space causing empyema • Pleural fibrosis • Trapped lung • Respiratory failure • Bronchopleural fistula

18. Treatment Antibiotic therapy Clindamycin is the treatment of choice .. Can combine Penicillin + Flagyl Other options: carbopenems, quionlones with good anaerobic activity

19. Endoscopic drainage is considered if an airway connection to the cavity Bronchoscopy Adequate dental or oral hygiene Diet rich in calories and proteins Postural drainage and chest physiotherapy

20. Postural drainage

21. Surgical intervention • Surgery is rarely required for patients with uncomplicated lung abscess. The usual indications for surgery are • -- failure to respond to medical management, • -- suspected neoplasm, or • -- congenital lung malformation. • Either percutaneous catheter drainage or surgical resection. • Lobectomy or pneumonectomy

23. Nursing assessment Assess the respiratory rate, rhythm Auscultate lung sounds Identify the type of chest pain Assess for shortness of breath Observe skin color , characteristics of secreations

24. Nursing management Impaired gas exchange related to decreased ventilation and mucous plugs Ineffective airway clearance related to excessive secretion and ineffective coughing Anxiety related to acute breathing difficulties and fear of suffocation Activity intolerance related to inadequate oxygenation and dyspnoea