Lung Abcess & Empyema (pathology)

Question 1

What is a lung abscess?

Answer 1

Collection of pus, surrounded by granulation tissue

• Abscess tends to go towards surface and discharge pus
• can have air fluid level

Question 2

Causes/risk factors for lung abscess

Answer 2

• Aspiration, incl foreign body
• Pneumonia
• PTE
• Lung cancer
• Septic emboli

Question 3

Management/treatment of lung abscess

Answer 3

DRAIN

Question 4

What is empyema? (& empyema thoracic)

Answer 4

Empyema= pus in pleural cavity

Empyema thoracis: spread to whole pleural cavity

Question 5

Causes/risk factors for empyema

Answer 5

• Post op
• Post pneumonic
• Oesophageal-> Boerhaave syndrome
  
  • spontaneous perforation of oesophagus from a sudden increase in intraesophageal pressure with negative intrathoracic pressure -severe straining or vomiting
• Upper abdominal related
• Osteomyelitis
• Post trauma
• Rib fracture/stab wound= haemothorax – remove blood from pleural space (chest drain or thoracoscopic surgery)

Question 6

Management/treatment of empyema

Answer 6

• haemothorax – remove blood from pleural space (chest drain or thoracoscopic surgery)
• Pleurectomy & decortication (take off fibrous tissue from lung surface)
• Lung doesnt go back to full expansion (80-90%)