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    Lung Abscess

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    Armoured Spartan
    This document provides an overview of lung abscesses, including: - Lung abscesses are defined as areas of pus or necrosis in the lung caused by microbial infection. They can be primary, arising from direct lung infection, or secondary, occurring with a predisposing condition. - Pathogenesis depends on the cause, such as aspiration, hematogenous spread, direct extension, or bronchial obstruction impairing drainage. - Risk factors include dental/sinus infections, alcoholism, and neurological impairments. Differentials include empyema and various lung cancers/infections. - Treatment involves antibiotics targeting common bacteria like Pseudomonas, plus drainage procedures or surgery for complications or

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    © All Rights Reserved
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    Lung Abscess

    Uploaded by

    Armoured Spartan
    82 views30 pages
    This document provides an overview of lung abscesses, including: - Lung abscesses are defined as areas of pus or necrosis in the lung caused by microbial infection. They can be primary, arising from direct lung infection, or secondary, occurring with a predisposing condition. - Pathogenesis depends on the cause, such as aspiration, hematogenous spread, direct extension, or bronchial obstruction impairing drainage. - Risk factors include dental/sinus infections, alcoholism, and neurological impairments. Differentials include empyema and various lung cancers/infections. - Treatment involves antibiotics targeting common bacteria like Pseudomonas, plus drainage procedures or surgery for complications or

    Original Title

    LUNG ABSCESS

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    This document provides an overview of lung abscesses, including: - Lung abscesses are defined as areas of pus or necrosis in the lung caused by microbial infection. They can be primary, arising from direct lung infection, or secondary, occurring with a predisposing condition. - Pathogenesis depends on the cause, such as aspiration, hematogenous spread, direct extension, or bronchial obstruction impairing drainage. - Risk factors include dental/sinus infections, alcoholism, and neurological impairments. Differentials include empyema and various lung cancers/infections. - Treatment involves antibiotics targeting common bacteria like Pseudomonas, plus drainage procedures or surgery for complications or

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    82 views30 pages

    Lung Abscess

    Uploaded by

    Armoured Spartan
    This document provides an overview of lung abscesses, including: - Lung abscesses are defined as areas of pus or necrosis in the lung caused by microbial infection. They can be primary, arising from direct lung infection, or secondary, occurring with a predisposing condition. - Pathogenesis depends on the cause, such as aspiration, hematogenous spread, direct extension, or bronchial obstruction impairing drainage. - Risk factors include dental/sinus infections, alcoholism, and neurological impairments. Differentials include empyema and various lung cancers/infections. - Treatment involves antibiotics targeting common bacteria like Pseudomonas, plus drainage procedures or surgery for complications or

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 30

    LUNG ABSCESS

    DR. MOHAMMAD ASIM

    CONSULTANT PULMONOLOGIST

    NORTHWEST GENERAL HOSPITAL AND RESEARCH


    CENTER
    LEARNING OBJECIVES
    • DEFINITON

    • CLASSIFICATION

    • PATHOPHYSIOLOGY

    • PRESENTATION

    • RISK FACTORS

    • DIFFERENTIALS

    • WORKUP

    • TREATMENT
    DEFINITION
    ‘Lung abscess is defined as a circumscribed area of pus or necrosis in the pulmonary parenchyma caused
    by microbial infection.’
    CLASSIFICATI
    ON

    PRIMARY SECONDARY
    LUNG LUNG
    ABSCESS ABSCESS
    PRIMARY LUNG ABSCESS

    • Primary lung abscesses result from direct infection of the pulmonary parenchyma in an otherwise
    healthy person.

    • Most result from aspiration of oral or gastric contents.

    • Primary lung abscesses can also arise within an area of pneumonia caused by necrotizing
    organisms (eg, s. Aureus).
    SECONDARY LUNG ABSCESS

    • Secondary lung abscesses occur when there is a predisposing condition such as bronchial
    obstruction (eg, foreign body, neoplasm), hematogenous spread (eg, right-sided endocarditis),
    thoracic surgery, or impaired host defenses.
    PATHOGENESIS

    Pathogenesis depends upon the cause. Some of the important mechanisms of lung abscess
    formation are ;
    1. Aspiration
    2. Hematogenous spread
    3. Direct extension
    4. Bronchial obstruction
    5. Superinfection or spread of airway infection
    ASPIRATION

    • Lung abscess is classically caused by aspiration of oropharyngeal secretions especially in patients with dental, gingival, or
    periodontal infection or paranasal sinusitis.

    • Impaired swallowing and enteral feeding while supine are risk factors.

    • Infection is initiated either because the secretions are not cleared due to suppressed consciousness, because the inoculum
    size is large, or due to impaired host defenses.

    • Pneumonitis arises first and then progresses to tissue necrosis after 7 to 14 days.
    HEMATOGENOUS SPREAD

    •  Lung abscesses can occur as a consequence of septic embolization during bacteremia (eg,

    tricuspid valve endocarditis, intravascular catheters, intravenous (IV) drug use, or lemierre

    syndrome [ie, jugular vein suppurative thrombophlebitis]). 


    DIRECT EXTENSION

    •  A lung abscess may develop by direct extension of an empyema, subphrenic, or mediastinal

    abscess or a tracheo-esophageal or broncho-esophageal fistula.


    BRONCHIAL OBSTRUCTION

    Endobronchial obstruction from a

    • bronchogenic or mediastinal mass (eg, aneurysm, lymphadenopathy, tumor)

    • bronchial stenosis or

    • inhaled foreign body

    may result in postobstructive pneumonia that progresses to abscess formation presumably due to impaired drainage of local

    pulmonary secretions.
    SUPERINFECTION

    • Lung abscess may develop as a superinfection of pulmonary infarcts, congenital malformations, or


    lung contusion.

    • Flares of bronchiectasis can lead to parenchymal infection that evolves into a lung abscess in a
    minority of patients.

    • The mechanism is likely multifactorial and includes poor drainage and impaired clearance of
    microbiologic flora from the lower airways.
    RISK FACTORS

    • Periodontal disease

    • Alcoholism

    • Coma

    • Drug abuse

    • Seizure disorder

    • Reflux disease

    • Neuromuscular diseases

    • Stroke
    DIFFERENTIAL DIAGNOSIS

    What do you think?


    • Empyema • Pneumonia
    • Hydatid cyst • Pulmonary embolism with infarction
    • Infective endocarditis • Cryptogenic organizing pneumonia
    • Small cell lung cancer • Sarcoidosis
    • Non small cell lung cancer • Rheumatoid nodules
    • Foreign body aspiration • Tuberculosis
    • Pulmonary Langerhans histiocytosis • Granulomatosis with Polyangiitis
    ETIOLOGY

    Common Uncommon
    Bacteria
    Bacteria
    Pseudomonas aeruginosa
    Rhodococcus equi
    Enterobacteriaceae
    Nocardia spp
    Legionella spp
    Mycobacteria
    Anaerobic bacteria and microaerophilic streptococci (eg, Streptococcus milleri)
    M. avium complex
    Staphylococcus aureus
    Mycobacteria Other nontuberculous mycobacteria
    M. tuberculosis
    Fungi
    M. kansasii
    Fungi
    Agents of mucormycosis 
    Cryptococcus spp Blastomyces dermatitidis
    Aspergillus spp
    Pneumocystis jirovecii (formerly P. carinii)
    Histoplasma capsulatum
    CLINICAL FEATURES
    Symptoms evolve over weeks to months.
    • Fever and chills (80 %)

    • Productive cough (often putrid, sour-tasting; 55 to 90 %)

    • Dyspnea (10 %)

    • Chest pain (20 to 35 %)

    • Hemoptysis (10 %)

    • Night sweats

    • Weight loss and anorexia

    • Fatigue
    WORKUP

    • CBC

    • Blood C/S both aerobic and anaerobic

    • Sputum for gram stain, culture and sensitivity


    CXR

    R.M.L abscess
    CXR
    CT SCAN
    TREATMENT

    ANTIBIOTICS

    1. Beta lactamase inhibitors (ampicillin-sulbactam) + Carbapenems (meropenem, imipenem)

    2. Penicillin allergy : Clindamycin + Levofloxacin + Metronidazole

    3. MSSA : Cefazolin, Nafcillin or Oxacillin

    4. MRSA : Vancomycin or Linezolid


    DURATION OF ANTIBIOTICS

    •  In general, we switch from IV to oral agents once the patient has defervesced and become
    clinically stable; for some patients this takes a few days while in others it may be one to three
    weeks

    • The optimal total duration of therapy (IV plus oral) is unknown; reported ranges include 21 to 48
    days.

    • Some experts treat for three weeks as a standard and others treat based upon the response.
    FAILURE OF ANTIMICROBIAL THERAPY
    1. NEEDLE OR CATHETER DRAINAGE
    • Transthoracic (percutaneous) catheter drainage
    • Transbronchoscopic catheter drainage

    2. TREATING ENDOBRONCHIAL OBSTRUCTION 


    • Rigid / flexible bronchoscopy for foreign body
    • Lobectomy for tumor
    • Endobronchial balloon/stent/laser for bronchial stenosis
    SURGICAL INTERVENTION 
    Mostly done when complications (hemorrhage, bronchopleural fistula) develop.
    Procedures include :

    1. LOBECTOMY – Large abscesses

    2. PNEUMONECTOMY – Large abscess

    3. SEGMENTECTOMY – Small abscess

    4. WEDGE RESECTION – Peripheral small abscess

    5. VATS – Procedure of choice


    VIDEO ASSISTED THORACOSCOPIC SURGERY
    THANKYOU!
    ANY QUESTIONS?

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