Updated: 4/19/2014

Lung Abscess

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Topic
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N/A
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Questions
2
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100%
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Evidence
8
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Topic
Introduction
  • lung abscessSuppurative inflammation of lung tissue within normal parenchyma
    • result of autodigestion of tissue by inflammatory cells
  • Etiology
    • most often a result of
      • aspiration of oropharyngeal material
      • bronchial obstruction
        • e.g. cancer
      • sequela of bacterial pneumonia
    • common pathogens include Bacteroides, Peptostreptococcus, Fusobacterium
    • more often seen in the right lung than the left
      • result of wider and straighter right mainstem bronchus
    • if multiple foci present the cause is most likely hematogenous spreading
  • Risk factors
    • poor oral hygiene
    • impaired swallowing
    • immunosuppression
    • altered consciousness
      • includes seizures, dementia and alcoholism  
Presentation
  • Symptoms
    • fever, malaise
    • cough with sputum production
      • putrid or foul-smelling sputum
    • weight loss, night sweats (subacute)
Evaluation
  • CXR
    • infiltrates often with cavity in dependent portion of lung (depends on position)
      • air-fluid level in cavity 
  • Labs
    • leukocytosis
  • Sputum
    • may be helpful to identify etiologic organism though contamination is common

 

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Questions (2)

(M1.PL.13.78) An 86-year-old male with a past medical history significant for an MCA stroke presents with recurrent fevers. He is currently living in a nursing home facility. A chest radiograph was obtained and is shown in Figure A. Which of the following is the most likely causative organism for this lesion?

QID: 100881
FIGURES:
1

Mycobacterium tuberculosis

17%

(9/54)

2

Bacteroides spp.

33%

(18/54)

3

Pseudomonas aeurginosa

20%

(11/54)

4

Streptococcus pyogenes

0%

(0/54)

5

Klebsiella pneumoniae

30%

(16/54)

M 2 E

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