0521779407-13 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:15
Lung Abscess 919➣Septic emboli from bacterial endocarditis
➣Necrotic conglomerate lesions of silicosis and pneumoconiosis
Signs & Symptoms
■Insidious presentation, symptoms usually present for 2–3 wks
■Cough, sputum, fevers, chills, sweats, anorexia, pleuritic chest
pain
■Foul-smelling sputum in 50–60%; indicates anaerobic infection
■Acute: symptoms are those of acute pneumonia; nonanaerobic such
asS aureusorK pneumonia
■Chronic: symptoms for more than 2 wks; anaerobic
■Exam: fever, poor dental hygiene, clubbing
■Early: signs are those of pneumonia with egophony, dullness to per-
cussion
■Later: breath sounds become amphoric over involved lung, clubbing
may occurtests
Laboratory
Basic blood tests:
■Often marked leukocytosis and reactive thrombocytosis
■Blood cultures can be positive with pyogenic infection
■Basic tests: sputum most often polymicrobic
➣Gram stain/culture for pyogenic infections:S aureus, K pneumo-
nia, E coli, P aeruginosa, S pyogenes, H influenza, L pneumophilia,
N asteroides, Actinomyces, S pneumonia
Imaging
■CXR: thick walled cavity with irregular lumen of lucency, or air-fluid
level within an area of pneumonia
■Usual location of abscess due to aspiration (85%): superior segment
of RLL and LLL and axillary sub-segment of anterior/posterior seg-
ments of RUL
■CT of chest can help distinguish abscess from empyema with bron-
chopleural fistuladifferential diagnosis
■Empyema
■Necrotizing squamous cell CA
■Multiple cavitary lesions suggest necrotizing pneumonitis, not
anaerobic infection
■Fluid filled bleb or cyst