Lung Infection: Lung Abscess
This casestudy most have the following :
1. Describe patient history and symptoms
2. Describe patient population affected, frequency
3. Description of modality used including view, positioning , techniques
4. Advantages and disadvantages over other modalities
5. Review of image finds ( can include other supporting test results
6. Diagnosis discussion of pathology
7. Treatment options
Lung Infection: Lung Abscess
Patient history and symptoms
abscess occurs in two instances either primary or secondary. Primary lung
abscess occurs in healthy people after they acquire a lung infection or when
the patient is prone to aspiration of nasopharyngeal/oropharyngeal material.
The aspiration occurs when cough and swallowing reflexes are impaired if the
patient suffers from epileptic seizures, is a drug addict, is an alcoholic, or
stays in a state of unconsciousness (Kuhajda, I., et al 2015). Secondary lung
abscess occurs in people whose bronchus is mechanically obstructed due to a
number of reasons such as general immunosuppression, foreign body,
endobronchial material, and mediastinal sepsis among others. Symptoms of lung
abscess include rapid heart rate, fever and chills, appetite loss, chest pain,
excessive sweating, weight loss, fatigue, deep cough with sputum, fatigue, and
blue skin (Kuhajda, I., et al 2015).
Patient population affected, frequency
The prevalence of lung abscess has reduced due to the
development and advancement of antibiotic therapy. The sections of the
population most affected include alcoholics, AIDS and cancer patients, people
with poor dental hygiene or periodontal diseases, diabetes mellitus patients,
patients under artificial ventilation, and patients with neuromuscular
disorders. One in 500 people is reported to acquire lung abscess but with less
than 10% cases of hospitalization because of the condition on its own (Loukeri,
A. A., et al 2015).
Modality used including view, positioning, techniques
tomography is the best radiographic modality used for chest imaging to diagnose
lung abscess by examining the lung cavitation (Loukeri, A. A., et al 2015). It
is more sensitive in viewing ratios of air and fluid in the bronchus. It may be
followed by bronchoscopy that entails passing a flexible, hollow tube into the
windpipe to view bronchial passages.
Advantages and disadvantages over other modalities
Computed tomography is more sensitive in assessing pulmonary pathology than ultrasound and plain chest radiography. It overcomes the weakness of ultra sound caused by poor sound transmission in air-filled lungs. Also, the modality is superior to plain radiography because it shows cavity wall thickness that predicts malignancy of the cavities and also shows presence or absence of foreign bodies (Loukeri, A. A., et al 2015).
Review of image finds (can include other supporting test results)
Radiological findings indicate presence of single/multiple
thick-walled cavitation characterized by anomalous margins in either isolated
or consolidated areas in the lungs. Computed tomography provides the size and
location of the lesions and allows to distinguish between empyema and lung
abscess. Lung abscess manifests as a round cavity with thick walls and does not
press on adjacent bronchus. Other results include vasculitides, pulmonary
sequestration, cysts or infarction, and cystic bronchiectasis (Loukeri, A. A.,
et al 2015).
Diagnosis discussion of pathology
Diagnosis may involve occupying the oropharynx with gram negative tubes (Kuhajda, I., et al 2015). Isolation is possible to eliminate presence of tuberculosis. To rule out lung cancer, computed tomography is necessary to assess the nature of cavitation. To identify the exact type of lung abscess, the cavitation is assessed to identify whether it is single/multiple, bilateral/unilateral, peripheral/central, and whether there is surrounding infiltrate that eliminates rheumatoid arthritis (Kuhajda, I., et al 2015).
Management of lung abscess is based on empirical therapy
using broad-spectrum antibiotics. Treatment must be empirical to take into
account drug resistant bacteria and is succeeded by streamlining of antibiotics
as informed by microbial incidence from cultures obtained. For anaerobic
infection, clindamycin is recommended because of low resistance from causative
bacteria. Alternatively, lung abscess can be treated using cephalosporin or a
combination of cefuroxime and cefoxitin. For lung abscess caused by Methillicin-resistant
Staphylococcus aureus, the infection is treated with linezolid (Kuhajda, I., et
Clinical improvement occurs within three days with fever
subsidence and complete recovery in a week or more. Generally, the cure rate is
90% but prognosis is adversely affected by underlying factors such old age,
bronchial carcinoma, reduced level of consciousness, and pneumonia (Loukeri, A.
A., et al 2015).
Kuhajda, I., et al (2015). Lung abscess- etiology, diagnostic and treatment options. Annals of Translational Medicine 3(13), 183-190.
Loukeri, A. A., et al (2015). Diagnosis, treatment, and prognosis of lung abscess. Pneumon 28(1), 54-60. Retrieved 24th October 2016 from: http://www.pneumon.org/assets/files/844/file597_586.pdf