Lung Infection: Lung Abscess

Lung Infection:  Lung Abscess

Instructions:

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
8. Prognosis
9. References

Solution.

Lung Infection:  Lung Abscess

Patient history and symptoms

Lung 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

Computed 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).     

Treatment options

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 al 2015).       
Prognosis

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).  

References

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