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Lung abscess
From WikEM
Contents
Background
- Localized, suppurative necrotizing process occurring within the pulmonary parenchyma
- Microbiology
- Community-acquired: anaerobes (bacteroides, fusobacterium)
- Hospital-acquired: Staph, E coli, Klebsiella, pseudomonas, legionella
Causes
- Aspiration pneumonia (7-14 days to become lung abscess)
- Bacteremia from nonpulmonary infection
- Pulmonary infarction
- Infection as a result of penetrating chest trauma
- Primary and metastatic neoplasms
- Granulomatosis with polyangiitis (Wegener's), sarcoidosis
Clinical Features
- Cough, fever, pleuritic chest pain, wt loss, night sweats (generally over course of several weeks)
- Tachycardia, tachypnea, or fever may be absent
Differential Diagnosis
- Cavitary lesion with air-fluid level
- Infected bullae
- Pleural fluid collection with bronchopleural fistula
- Loop of bowel extending through diaphragmatic hernia
Evaluation
- CXR or CT Chest
- Dense consolidation with air-fluid level inside of a thick-walled cavitary lesion
- Air-fluid level indicates communication of abscess cavity with a bronchiole
Management
- Medical management will successfully treat 70-90% of lung abscesses
- Drainage occurs spontaneously from communication of cavity with tracheobronchial tree
- Bronchoscopic drainage may result in seeding other parts of the lung
- Antibiotics
- Clindamycin + 2nd or 3rd gen cephalosporin OR
- Clindamycin + ampicillin/sulbactam
Complications
- Empyema
- Massive hemoptysis
Disposition
- Admit
