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Updated: Dec 22 2021

Lung Abscess

  • 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
    • 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
    • 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)
  • 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
  • Prognosis
    • Morbidity and mortality improved with antibiotics
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