Page 7 / Case 01/01
SYNOPSIS
The following is a brief synopsis of the discussion on lung abscess that followed the case presentation:
Definition
An
abscess is a localized, advanced suppurative infection that affects one
or several areas of lung parenchyma.
– primary: no predisposing factors
– secondary: with predisposing factors (see table below under pathogenesis)
Incidence
& Prognosis
–
decreased
incidence since modification of ENT surgical techniques. Once abandoned
seated positioning and uncuffed endotracheal tubes, decreased occurrence
of post-op lung abscesses.
– decreased
mortality from lung abscess after introduction of antibiotics (penicillin)
– mortality
rate still remains high: 10 - 38%
Pathogenesis
Lung
abscesses may occur as a result of any of the following :
– oropharyngeal
aspiration
– inhalation
– direct
inoculation
– contiguous
spread
– hematogenous
spread
Open
TABLE 1
Predisposing factors to lung abscess (children)
Open TABLE
1a Coexistent conditions in lung abscess (adult and children)
Clinical
Features
Open
TABLE 2
(symptoms)
–
dependent
lung segments are most often affected. Hence, posterior segments of upper
lobes & superior segments of lower lobes.
–
Chest
Xray or CT chest to confirm. Often do not need sophisticated imaging,
but CT chest may show disease prior to Chest Xray. CT also helpful to
distinguish abscess from pyopneumothorax.
– low likelihood of malignancy in pediatric population.
