Updated: 8/25/2018

Lung Abscess

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Snapshot
  • A 52-year-old man presents to the emergency department with a cough, foul-smelling sputum, and a subjective fever. He is homeless and has a history of alcohol-use disorder. His temperature is 102.2°F (39°C). A radiograph of the chest demonstrates a thick-walled cavitary lesion. He is admitted to the hospital for empiric antibiotic treatment.
Introduction
  • Definition
    • parenchymal necrosis of the lung caused by a microbial infection
      • this leads to the development of a circumscribed collection of pus
  • Epidemiology
    • incidence
      • most common cause is aspiration
  • Etiology
    • anaerobic bacteria is the most common cause
    • polymicrobial in cases of aspiration
    • monomicrobial causes include
      • group A streptococci
      • Staphylococcus aureus (including MRSA)
      • Klebsiella pneumoniae
      • Nocardia (in immunocompromised patients)
  • Pathophysiology
    • aspiration leads to bacterail inoculation in the lung parenchyma → lung parenchyma necrosis (within 7-14 days) → abscess formation
      • foul smelling sputum results if the abscess communicates with the airway
  • Prognosis
    • morbidity and mortality improved with antibiotics
Presentation
  • Symptoms
    • cough
    • foul-smelling sputum
  • Physical exam
    • weight loss
    • fever
Imaging
  • Chest radiography
    • indication
      • imaging of choice and diagnostic in patients with signs and symptoms concerning for abscess
    • findings
      • cavity with an air-fluid level
Studies
  • Microbiology testing from sputum or respiratory specimen
Differential
  • Empyema
    • differentiating factor
      • radiography typically demonstrates opacifying lesion
Treatment
  • Medical
    • intravenous empiric antibiotics
      • indication
        • mainstay of treatment
      • medications
        • clindamycin
          • be cautious for C. difficile infection
        • carbapenem (e.g., imipenem or meropenem)
        • ampicillin-sulbactam
Complications
  • Death

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