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Updated: Apr 19 2014

Lung Abscess

  • Introduction
    • Suppurative 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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