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Lung Abscess

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

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  1. Lung Abscess Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine

  2. Definition • Infection of the lung parenchyme consisting of one or more necrotic inflammatory cavities, containing fibropurulent exudates and gaseous materials

  3. 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

  4. Duration Acute < 4-6 week Chronic Causes Primary Secondary Classifications

  5. Symptoms of Lung Abscess • Cough : 77% • Sputum : 65% • Fever and chills : 40% • Chest pain : 24% • Hemoptysis : 16% • Dyspnea : 15% • Anorexia : 4% • Night sweats : 1 %

  6. 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

  7. Necrotizing Pneumonia • Community :Staph. Aureus or Klebsiella • Hospital : Pseudomonas or Proteus • Aspiration pneumonias cause necrotizing infections • Klebsiella predominant in alcoholics or DM

  8. Secondary to Malignancy • Bronchogenic cancer : Squamous Ca • Lymphoma • Leukemia • Multiple Myeloma • Metastatic Malignancies

  9. 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

  10. Treatment • Medical treatment is the mainstay • Pennicillin, Cephalosporin • Clindamycin, chloramphenicol, Metronidazole to cover for the Anarobes • Postural drainage • Bronchoscopic drainage

  11. Indications for Surgery • Massive hemoptysis • Refractory to Medical treatment • Large cavity with thick walls • Complicated by malignancy • Empyema develops • Chronicity, Recurrence • Remaining residual cavity

  12. Prognosis • Relatively Favorable • Underlying Disease is important • Operation Rate : 15% • Overall mortality rate : 10%

  13. 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

  14. Lung Abscess Cavity with “Air-Fluid level”

  15. Lung Abscess Left Upper Lobe Posterior Segment

  16. Lung Abscess Pseudomonas Lung Abscess

  17. Lung Abscess Malignant Abcess Cavity

  18. Septic Pneumonia Multiple Bilateral Septic Emboli multiplr

  19. Septic Emboli Septic Emboli in Pulmonary arteries : H & E

  20. Empyema

  21. Empyema

  22. Empyema pus diaphragm

  23. 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

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