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Company LOGO LUNG ABSCESS Ida Mujahidah Nur Ahmad Tab DEPARTMENT OF INTERNAL MEDICINE MEDICAL FACULTY – HASANUDDIN UNIVERSITY MAKASSAR
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LUNG ABSCESS
Ida MujahidahNur Ahmad Tabri
DEPARTMENT OF INTERNAL MEDICINEMEDICAL FACULTY – HASANUDDIN
UNIVERSITYMAKASSAR
LUNG ABSCESSIntroduction
Workup
Etiology
Pathophysiology
Clinical Manifestation
Diagnosis
Differential Diagnosis
Therapy
Preventive
Prognosis
I. INTRODUCTION
Lung Abscess
Lung abscess is a cavity in the lung tissue containing purulent material
containing inflammatory cells from necrotic lung parenchyma due to
the process of infection
When the cavity
diameter> 2 cm and
polynomial (multiple
small abscesses)
called necrotizing pneumonia
Large or small abscess have
different clinical manifestations,
but have the same predisposition and the same principle
of differential diagnosis anyway.
High virulence
decrease in the body's defense
mechanism
I. INTRODUCTION
ABCESS
aspiration of infected objects
Men > women with ratio 3,5 : 1
ElderlyUrban areas withprevalence of alcoholismwho reported high at age 41 years
I. INTRODUCTION
LUNG ABSCESSIntroduction
Workup
Etiology
Pathophysiology
Clinical Manifestation
Diagnosis
Differential Diagnosis
Therapy
Preventif
Prognosis
II. ETIOLOGY
Traumatic lung injury
abscess expansionto subdiafragma
complications ofpneumonia
infection throughthe airway
Lung infection
II. ETIOLOGY
Anaerob bacteria
Aerob bacteria
Fungi
Parasite, amoeba
Mycoobacteria
microorganisms thatcause lung abscess
LUNG ABSCESSIntroduction
Workup
Etiology
Pathophysiology
Clinical Manifestation
Diagnosis
Differential Diagnosis
Therapy
Preventif
Prognosis
III. PATHOPHYSIOLOGI
ASPIRATION
HEMATOGEN
LUNG ABSCESS
III. PATHOPHYSIOLOGI
11
44
commensal bacteria in the upper respiratory tract took into the lower
respiratory tract
Due to recurrent aspiration, aspiration can not be removed and resulting in decreased in
airway defense cause inflammation
22
33Aspiration
Extension to the pleura or relationship with bronchi often occurs that pus or
necrotic tissue can be removed
Inflammatory process starts from the bronchi or bronchioles, spread to the lung parenchyma is then surrounded
by granulation tissue
III. PATHOPHYSIOLOGI
Asepticemia or as a septic
emboli phenomenon
Bsecondary of focus of infection from other parts of the body
such as tricuspid valve endocarditis
CHematogenous spread generally will form multiple abscesses and is usually caused by staphylococcal
HEMATOGEN
III. PATHOPHYSIOLOGI
Lung abscess in the right lobe of the lung and pleural cavity
Lung abscess in the right lobe of the lung and pleural cavity
When rupture and penetrate to the diaphragm
Bacterial Liver
Abscess
AmoebicLiver
Abscess
LUNG ABSCESSIntroduction
Workup
Etiology
Pathophysiology
Clinical Manifestation
Diagnosis
Differential Diagnosis
Therapy
Preventif
Prognosis
IV. Clinical Manifestation
Malaise, weight loss
cough with phlegm
intermitent febris
after the cavity, then smelling sputum is a typical sign. Sputum shaped greenish
yellow pus, sometimes accompanied by blood. Respiratory patients also smells
SputumSputum
night sweats
Usually patients with lung abscess came after 2 weeks
IV. Clinical Manifestation
Takayanagi dkk
Weight loss
(8,3%)
Fever (81,5%)
Chest pain
(37,1%)
Anorexia(18%)
Sputum with
blood(22%)
Cough with
pleghm (55,6%)
Malaise(12,2%)
Asymptomatic(2%)
IV. CLINICAL MANIFESTATION
On physical examination, initial clinical picture is similar to
pneumonia
Signs of consolidation
such as bronchial
sound with wet rales or crackles in the abscess
signs of pleural effusiondull to
percussion
Sometimes symptoms of
finger clubbing was
found
LUNG ABSCESSIntroduction
Workup
Etiology
Pathophysiology
Clinical Manifestation
Diagnosis
Differential Diagnosis
Therapy
Preventif
Prognosis
V. WORKUP
• Leukocytosis, especially
PMNBSR can ↑
• Microorganisms cause
abscesses was found from transtrakeal aspiration,
transthoracic, or bronchial
washings
For examination aerobic and anaerobic bacteria
Lab
But some clinician said that culture resistance of anaerob bacteria in the smell lung abscess is not necessary because is
rather difficult and expensive
MucusBlood and
sputum cultures
V. WORKUP
Typical: irregular cavity with air-fluid level
Often the posterior segment of the upper lobe or lower lobe superiorAbscesses may extend to the pleural surface forming an acute angle with the surface of the pleura
V. WORKUP
Visualization of anatomy better than chest X-ray
Identify abscess or empyema accompanied pulmonary infarctionAbscesses appear as round radiolucent lesion with thick walls and irregular boundaries
Can show the location of the abscess in lung parenchyma and distinguishing with empyema
CT Scan
V. WORKUP
Takayanagi
Right middle lobe3,4%
Multiple right lobe 3,9%
Multiple left lobe 2%
Right upper lobe 35,1% Left lower lobe 19%
Bilateral 8%
Right lower lobe 15,6%Left lower lobe13,1%
LUNG ABSCESSIntroduction
Workup
Etiology
Pathophysiology
Clinical Manifestation
Diagnosis
Differential Diagnosis
Therapy
Preventif
Prognosis
VI. DIAGNOSIS
anamnesis andphysical examination
anamnesis andphysical examination
lesion cavity roundwith air-fluid level on CXR
lesion cavity roundwith air-fluid level on CXR
microbes foundIn the analysis of sputum
microbes foundIn the analysis of sputum
DIAGNOSISDIAGNOSIS
LUNG ABSCESSIntroduction
Workup
Etiology
Pathophysiology
Clinical Manifestation
Diagnosis
Differential Diagnosis
Therapy
Preventif
Prognosis
VII. Differential Diagnosis
Lung Hematom
Infected bullae
Lung Abscess
DD
Tuberculosis or Fungi infection
bronchogenic carcinomawith cavitation
Pneumoconiosis with cavitation
Infected Lung cysts
LUNG ABSCESSIntroduction
Workup
Etiology
Pathophysiology
Clinical Manifestation
Diagnosis
Differential Diagnosis
Therapy
Preventif
Prognosis
VIII. Therapy
EmpiricalCausing
microbesUnderlying
disease
Until now there is no specific recommendation from the respiration medical association
about complete therapeutic on pulmonary abscess
VIII. Therapy
Anaerob&Aerob
infection
Clindamycin 600 mg IV q8h followed by 150-300 mg qid
aerobbacteri
a
β-laktam/ β-laktamase inhibitor, cephalosporin , fluoroquinolon
Allewelt et alcomparing ampicillin +
Sulbactam vs. Clindamisin ± cephalosporin obtained both well tolerated and effective
Allewelt et alcomparing ampicillin +
Sulbactam vs. Clindamisin ± cephalosporin obtained both well tolerated and effective
Polenakovik et almoxifloksasin 400 mg qd orally 4- 8
weeks were given to patients after
standard initial therapy (ampicillin-
sulbactam, clindamisin,
ceftriaxone, and levofloxacin) obtain
clinical and radiological
improvement, and found no relapse
Polenakovik et almoxifloksasin 400 mg qd orally 4- 8
weeks were given to patients after
standard initial therapy (ampicillin-
sulbactam, clindamisin,
ceftriaxone, and levofloxacin) obtain
clinical and radiological
improvement, and found no relapse
VIII. Therapy
VIII. Therapy
Medical treatment is usually given in the long term, ranging from 1-3 months
Medical treatment is usually given in the long term, ranging from 1-3 months
usually unsuccessful,in patients with
poor prognostic factors
Abscess > 6 cm
Malignancy
ElderlyUnconsciousne
ss
Aerob pathoge
n bacteria infectio
n
Imunocompromised
VIII. Therapy
Long-term systemic antibiotic therapy is generally successful anddoes not require interventional procedures
Drainage is needed in approximately 11-21% of cases that failwith medical therapy
PhysiotherapySputum drainage
Posturaldrainage
VIII. Therapy
CT-guided percutaneous drainage should be considered as an initial treatment option in patients who failed to medikamentosa
The success of lung abscess drainage withCT guidance was 90%,
If it is not possible to do percutaneous drainage with CT guidance, the actions that can be done is endoscopic drainage
VIII. Therapy
Endoscopic drainage
first reported in 1954. In the study performed by Felix Herth
catheter is inserted through the nose using flexible bronchoscopy, then sprayed gentamicin 80 mg in 20ml NaCl twice a day in abscess cavity
Endobrakial catheter, carried an average of 4-6 days. Use is relatively safe and effective in patients with
abscesses located near the main airway
rarely performed on uncomplicated lung abscesses. Surgical form is a resection surgery with lobectomy or
pneumektomi on multiple abscesses
Dekel Shlomi et al
Surgical Therapy
VIII. Therapy
VIII. Therapy
LUNG ABSCESSIntroduction
Workup
Etiology
Pathophysiology
Clinical Manifestation
Diagnosis
Differential Diagnosis
Therapy
Preventif
Prognosis
IX. Preventif
Improve lifestyleMaintain oral healthPatients with chronic diseases, avoid the
occurrence of aspiration, malnutrition, and increase immunity status
Patients with decreased consciousness, aspiration prevented with frequent secret sucking
In conscious patient, respiratory physiotherapy and exercise of cough reflex are done
Avoiding the use of general anesthesia in tonsillectomy
LUNG ABSCESSIntroduction
Workup
Etiology
Pathophysiology
Clinical Manifestation
Diagnosis
Differential Diagnosis
Therapy
Preventif
Prognosis
X. Prognosis
1936
1935-1945
Mortality 32-34%antibiotics have not been be used
Smith: essentially no impact in theuse of sulfonamides
antibiotic era → complete recoveryIn Lung abscess
Cure rate can bereached 90-95%Mortality currently only 5%
Duration of the abscessAbscess size
Abscess location
Elderly
Malnutrition
Malignancy
Immunocompromised
Risk Factors that worsen prognosis
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