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Monday, January 3, 2022

Lung Abscess: Causes, Signs, Diagnosis, Complications, Treatment, Prevention by Nurses Note

Lung Abscess

 Definition: Lung abscess is a localized collection of pus in the lungs caused by pyogenic organisms. It is usually a subacute infection. 

Causes of Lung Abscess

I. Infections

 A. Pyogenic bacteria: Staphylococcus aureus, Klebsiella, Gp. A Streptococci, Legionella sp., anaerobes

B. Mycobacteria: M. tuberculosis, M. kansasii,  M. avium intracellulare .

C. Fungi: Histoplasma capsulatum, Coccidiodes immitis, Aspergillus

D. Parasites: Amebas, lung flukes

II. Pulmonary Infarction

A. Pulmonary thromboembolism

B. Septic embolism (Staphylococcus aureus, anaerobes, Candida)

C. Wegener's granulomatosis

III. Neoplasm

A. Metastatic malignancies (very common)

B. Bronchogenic carcinoma

C. Lymphomas

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IV. Others

A. Infected cysts and bullae

B. Silicosis

C. Coal miner's pneumoconiosis 

Pathophysiology of Lung Abscess

Lung abscess is more common in the right lung. It is a solid yellow mass of inflammatory tissue surrounded by necrotic wall. As the disease progresses, the solid mass may be transformed to liquid pus. Microscopic-ally it consists of dense infiltration of polymorpho-nuclear leucocytes. Alveolar walls are destroyed. 

Clinical Features of Lung Abscess

It presents within l - 2 weeks. 

Symptoms of Lung Abscess

l. Onset: Insidious, acute, or chronic

2. Cough: Most common feature with copious expectoration of foul-smelling, greenish yellow and mucopurulent sputum. It may be rusty and blood-stained.

3. Pyrexia: High remittent fever with shivering and sweating

4. Chest Pain: Pleuritic pain if pleural surfaces involved

5. Generalized symptoms: malaise, lassitude, loss of weight, anorexia


Signs of Lung Abscess

1. Temperature: Very high with tachycardia

2. Clubbing of fingers

3. Dullness on percussion & few coarse crepitations during early phase

4. Signs of cavity or local consolidation may occur when pus is expectorated out

5. Signs of pleural effusion may mask other signs

Investigations of Lung Abscess

l. CBC: Polymorphonuclear leucocytes
2. Sputum: Pus cells, causative organisms on staining and culture.
3. Chest X-ray: Large homogenous opacity or a cavity showing a fluid level may be seen. Associated involvement of pleura may be noted by obliteration of CP angle.
4. Fiberoptic bronchoscopy: to rule out the bronchogenic cause of lung abscess
5. CT Scan if necessary

Complications of Lung Abscess

1. Dry pleurisy
2. Empyema
3. Pneumothorax
4. Brain abscess
5. Hemoptysis

Treatment of Lung Abscess

I. Chemotherapy: Appropriate antimicrobial therapy
2. Postural drainage and percussion therapy
3. Bronchoscopic aspiration
4. General measures: Bed rest, oxygen, high protein diet, breathing exercises
5. Surgery: Surgical resection may be required if there is no response to above measures or there
is massive hemoptysis, localized malignancy or bronchiectasis.

Prevention of Lung Abscess

The most common mode of acquiring lung abscess is following aspiration following tonsillectomy, oral surgery, nose-throat operations, following inhalation of vomitus during general anesthesia or coma 
or iatrogenic due to intermittent positive pressure breathing and nebulization. Care should be taken to 
prevent all of the above. 

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