Updated: 4/19/2014

Lung Abscess

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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 (3)
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(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? Tested Concept

QID: 100881
FIGURES:
1

Mycobacterium tuberculosis

20%

(9/46)

2

Bacteroides spp.

30%

(14/46)

3

Pseudomonas aeurginosa

15%

(7/46)

4

Streptococcus pyogenes

0%

(0/46)

5

Klebsiella pneumoniae

35%

(16/46)

M 2 E

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(M1.PL.13.16) A 33-year-old male is seen in your emergency department complaining of cough and shortness of breath with recent fevers and chills. His CT scan is shown in Figure A. Which of the following risk factors most likely caused his disease? Tested Concept

QID: 100819
FIGURES:
1

Occupational exposure

23%

(16/69)

2

IV drug use

16%

(11/69)

3

Alcoholism

35%

(24/69)

4

Smoking

26%

(18/69)

5

Poor diet

0%

(0/69)

M 2 E

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Evidence (7)
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