Suppurative Lung Disease-Tal

Question 1

Definition of suppurative lung disease

Answer 1

Lung diseases that are associated with significant amount of pus. Divided into lung abscess (in parenchyma, with necrosis) and bronchiectasis (in airways, which can be CF or non-CF)

Question 2

What are the causes for bronchogenic lung abscess?

Answer 2

Aspiration from URT and oral bacteria: Anesthesia, alcoholism, epilepsy, cerebrovascular disorders, drug intoxication, diabetic coma, dental extractions.  Bronchial obstruction (tumor, foreignbody, mucus plug) is a predisposing factor. Hematogenous: usually staph aureus. Necrotizing Pneumonias (increasing around the world). Infected lung cysts and bullae.

Question 3

What are the two clinical manifestations of lung abscess?

Answer 3

Acute (less common) : high fever, chills, cough, malaise.  Insidious (more common): cough, sputum, low-grade fever, malaise. Pleuritic pain and hemoptysis may present. Less specific.

Question 4

What other tests should be performed when suspecting suppurative lung disease?

Answer 4

Laboratory tests: Leukocytosis, purulent sputum. Radiography: CXR- Homogenous opacification , cavity with an air-fluid level. CT- scan Bronchoscopy: to rule out an obstruction, remove a foreign body or diagnose an endobronchial tumor.

Question 5

Treatment of lung abscess

Answer 5

Antibiotics. Otherwise surgical with CT-more with children if positive of diagnosis.

Question 6

Definition/cause of bronchiectasis

Answer 6

Dilated bronchi, associated with varying degrees of acute and chronic inflammation and fibrosis. Injury to cylinder wall. Varying degress of acute and chronic inflammation. Can be caused by foreign body stuck (or tumor), causing inflammation–>secondary bacterial infection–>more inflammation–>damage to bronchi–>bronchiectasis.

Question 7

What are the stages of bronchiectasis (pathology)

Answer 7

1. Cylindrical dilation, fusiform, of segmental bronchi (reversible), 2. Varicose (alternating dilation and constriction), 3. Saccular dilatation (with atelectasis of lobe and pleural thickening, destruction and vascular changes, need to be extracted)-both irreversible.

Question 8

Infections causing bronchiectasis

Answer 8

Bacterial pneumonia  Bordetella pertussis tracheobronchitis (becoming more common)  Adenovirus pneumonia  Measles pneumonia  Influenza pneumonitis (less common)  Mycoplasma pneumonitis. (less common)

Question 9

Congenital and Genetic disorders causing bronchiectasis

Answer 9

Any structural problem in connective tissue: Cystic fibrosis  -1 antitripsin deficiency  Deficient bronchial cartilage – Williams-Campbell synd.  Marfan synd. – connective tissue weakness.  Tracheomegaly

Question 10

Immunodeficiencies causing bronchiectasis

Answer 10

Any. Especially:  Hypogammaglobulinemia  SCID  Common variable hypogammaglobulinemia  IgG subclass deficiency  IgA deficiency  Neutrophil defdiciency - Job’s syndrome  Complement deficiency

Question 11

Causes of bronchiectasis

Answer 11

Infections, congenital, immunodeficiencies, Foreign body aspiration  GER-D – severe or recurrent aspiration  Ciliary abnormalities  Bronchogenic carcinoma  Autoimmune disorders (Rhueum. Arthritis).  Right middle lobe syndrome  Asthma.

Question 12

What can differentiate between bronchiectasis and asthma?

Answer 12

No clubbing in asthma. usually autoimmune diseases causing bronchiectasis.

Question 13

Signs and symptoms of bronchiectasis.

Answer 13

Nonspecific. Crackles 82%  Dullness to percussion 47%  Clubbing 46%  Bronchial breath sound 19%  Cyanosis 5%

Question 14

Causes to suspect bronchiectasis

Answer 14

Chronic productive cough. A child that is coughing more than 8 weeks, more in the morning when they wake up (but could also be postnasal drip). See a child with pneumonia who is not improving. Persistent lung crackles.

Question 15

What is the most specific and sensitive diagnostic tool for bronchiectasis?

Answer 15

High resolution CT (HRCT). But high radiation so only use for high suspicion of bronchiectasis. See dilated bronchioles.

Question 16

Treatment of bronchiectasis

Answer 16

Mostly medical. If early: reverse radiologic evidence and cure the patient. If late, minimize symptoms, maximize daily function, minimize progression of diseaes and prevent complications. No treatment is proven. Antibiotics short/long term (2 wks on/off). Postural drainage to keep lungs clean, hypertonic saline. Surgical treatment only if localized area of the lung that is very active. Make sure in HRCT that all other lung parenchyma is normal.

Question 17

Where are cilia mostly located?

Answer 17

Middle ear, sinuses, nasopharynx, tracheobronchial tree, spermatozoa, fallopian tubes. About 200/cell beating at 1000bpm.

Question 18

Symptoms and signs of cilia dyskinesia syndrome

Answer 18

2/3 of neonates have respiratory distress. 2/3 have situs inversus. Chronic/recurrent otitis media  Chronic sinusitis  Productive cough (84% have chronic cough)  Recurrent pneumonia  (male infertility), Inspiratory crackles  Hyperinflated chest  Prolonged expiration  Expiratory wheezing  Clubbing  Nasal polyps

Question 19

What is the definitive test for primary ciliary dyskinesia?

Answer 19

Electron microscopy of nasal epithelium. Also sweat test to rule out CF. Exhaled NO will be low in PCD but high in asthma.

Question 20

What is the treatment for PCD?

Answer 20

No cure, supportive treatment.