Lung Abscess Disease

BASICS

DESCRIPTION

A localized cavity in the lung with pus resulting from necrosis of lung tissue surrounded by lung infection. May be caused by aerobic or anaerobic infection. Usual course is sub-acute; progressive.

System(s) affected: Pulmonary
Genetics: No known genetic pattern
Incidence/Prevalence in USA: Unknown, relatively rare
Predominant age: Mainly 4th-6th decades
Predominant sex: Male > Female (4:1)

SIGNS AND SYMPTOMS

Cough
Sputum (purulent, foul-smelling)
Fever
Chest pain
Dyspnea
Chills, rigors
Malaise
Weight loss
Anorexia
Night sweats
Hemoptysis
Decreased breath sounds
Crackles
Wheezing
Tachypnea
Tachycardia
Diaphoresis
Dullness to percussion
Consolidation by auscultation
Cavernous breath sounds

CAUSES

Lung infection
Aspiration pneumonia
Necrotizing pneumonia
Cavitary infarction
Septic embolism
Bacteremia
Bronchial stenosis or obstruction
Tumors
Dental abscess in loose tooth

RISK FACTORS

Periodontal disease (gingivitis)
Alcoholism
Drug abuse
Epilepsy
Unconsciousness
Lung neoplasia
Immunosuppression/immunocompromised
Diabetes mellitus
Airway foreign body
Gastroesophageal reflux with aspiration
Sinusitis
Gastric and esophageal surgery
Dental and oropharyngeal surgery

DIAGNOSIS

LABORATORY

Leukocytosis
Anemia
Hypoalbuminemia
Sputum smear - mixed bacteria and neutrophils
Sputum culture - mixed flora, anaerobes
Gram-negative rods and cocci
Pleural fluid - neutrophilia
Bacteriology:
- Generally anaerobes
- Staphylococcus
- Klebsiella spp.
- Pseudomonas aeruginosa
- Other (uncommon)

Drugs that may alter lab results: Prior antibiotics
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Gross - solitary abscess
Multiple abscesses
Micro - suppuration
Cavitation

SPECIAL TESTS

N/A

IMAGING

Chest x-ray: consolidation with radiolucency
Air-fluid level
Pleural effusion
CT: define location and extent

DIAGNOSTIC PROCEDURES

Bronchoscopy if obstruction suspected
Bronchoscopic protected brushing
Bronchoalveolar lavage
Transthoracic needle aspiration

TREATMENT

APPROPRIATE HEALTH CARE

Inpatient if ill, otherwise outpatient
Inpatient surgery

GENERAL MEASURES

Postural drainage
Pulmonary physiotherapy
Treat underlying etiology (e.g., with antibiotics)
Bronchoscopy with selective therapeutic lavage - rarely

SURGICAL MEASURES

Rarely, surgery for complications (pulmonary resection)

ACTIVITY

Reduced activity until x-ray evidence of clearing

DIET

No restrictions

PATIENT EDUCATION

Pulmonary physiotherapy techniques

FOLLOW UP

PREVENTION/AVOIDANCE

Treat predisposing diseases

POSSIBLE COMPLICATIONS

Extension
Empyema
Massive hemoptysis
Pneumothorax
Brain abscess

EXPECTED COURSE AND PROGNOSIS

Without underlying disease, guardedly favorable. Increased sequelae and mortality with concomitant disease (up to 75% mortality).

MISCELLANEOUS

ASSOCIATED CONDITIONS

Pneumonia
Alcoholism
Epilepsy
Empyema
Periodontal disease
Unconsciousness
Neoplasia
Bronchogenic carcinoma
Tuberculosis
Fungal diseases

AGE-RELATED FACTORS

Pediatric: Occurs in children, Staphylococcus most common organism
Geriatric: Mortality higher in this age group
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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