lung abscess and empyema

Question 1

causes of lung abscess?

Answer 1

1. aspiration pneumonia (anaerobes)
2. bacterial pneumonia (STAPH)
3. lung cancer, foreign body, CF, bronchiectasis

Question 2

presentation of lung abscess? investigations?

Answer 2

-worsening pneumonia (fever, cough)
-copious, foul-smelling sputum
-finger clubbing if chronic

1. xray (spherical cavity with air-fluid level)
2. gram stain and culture of sputum
3. bronchoscopy if suspecting cancer

Question 3

treatment of lung abscess?

Answer 3

broad spectrum ABs covering aerobic and anaerobic (ceftriaxone PLUS metronidazole)
continue for 3-6 wks or until clinical/radiological improvement. surgical drainage if necessary

Question 4

empyema definition and causes?

Answer 4

pus in the pleural cavity due to ruptured lung abscess, pneumonia, or infected hemothorax

Question 5

clinical symptoms and investigations?

Answer 5

fever, very ill, cough, malaise, weight loss, and clubbing

xray: lens shaped opacity
chest CT: split-pleura sign (thickening of visceral and parietal pleura)
US: fluid collection

analysis of pus: pH<7.2, low glucose, gram stain and culture positive

Question 6

treatment of empyema?

Answer 6

broad spectrum antibiotics covering aerobic and anaerobic (ceftriaxone PLUS metronidazole). THORACOSTOMY to drain