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03-18-2009, 10:37 AM
Lung abscess
Aetiology :
1- Primary (aspiration or inhalation) mostly Rt. & basal




2- Secondary
►Lung D pneumonia
Infected cyst
Bronchial carcinoma
►Subdiaphragmatic Amoebic abscess.
Subphrenic abscess.
►Mediastinal & thoracic wall D.
Pathology
I. Pneumonic stage.
Area of consolidation
+ overlying acute pleurisy
II. Stage of acute abscess.
Suppuration & pus discharge into
near by bronchus leaving activity
with irregular wall + inflamed pleura
III. Chronic abscess.
Cavity with regular & smooth border
& the pleura become thickened.

Complication


Lung G.

1- Pneumonitis Toxemia.
2- Fibrosis Amyloidosis
3- Bronchiectasis Pyaemia
4- Pleurisy
5- Effusion
6- Empyema + pleural adhesion.
C/P:
I- Pneumonic stage FAH M
Pleurisy chest pain.
Cough - dyspnea
Signs of consolidation.
­ TVF Bronchial breathing +
bronchophony
II- Acute abscess
The pt gets a severe attack on 9th - 12th day of cough then expectoration of thick mucus plug followed by large (huge) foited (in case of anaerobs infection) sputum drop of fever & improvement of general condition.
Mucus plug
Signs TVF ­
Bronchial breathing
Coarse consonating crepitation
III- Chronic abscess


Mucus plug
Symptoms: Toxemia (fever sweating)
Signs:
General Toxemia - clubbing of finger
Local signs of cavity + fibrosis Retraction
TVF ­­ (dt the cavity)
Dullness
Bronchial breathing
dt the cavity
Investigation:
X-ray cavity with fluid level
Culture & Sensitivity. (for aerobes & anaerobs)
CT scan chest

DD of lung abscess (from other cavitary $)
Acute onset
Lung abscess ­­ on lying on healthy side
Retension $ is common (i.e. attack of cough
with expectoration of large amount of sputum and evacuation of the cavity and then reaccumulation occurs....)
Bronchiectasis gradual onset
long duration
bilateral basal ­­ with leaning forward
Infected cystic lung see later
Empyema with bronchopleural fistula. (Methylene blue test)

Treatment
1- postural drainage
2- Ab see pneumonia
Ab. also for anaerobs

Flagyl Clindamycin



(Dalacin-C)
3- Expectorant
4- Surgery
For resistant cases lobectomy or segmentectomy


N.B. Suppurative pneumonia is the term used to describe a form of pneumonic consolidation in which there is destruction of the lung parenchyma by the inflammatory process.
Although micro abscess formation is characteristic histological features, it is used to restrict the term pulmonary abscess to lesions in which there is large localized collection of pus.

Source: Internal Medicine Book of Dr.Osama Mahmoud (Ain Shams University)