Chapter 66: Lung Empyema and Abscess

Question 1

What is the most common precursor of emphyema

Answer 1

Bacterial pneumonia with parapneumonic
effusion

Question 2

Diagnostic criteria for empyema are
aspiration of grossly purulent material on thoracentesis and at least one of the following:

Answer 2

• thoracentesis fluid with a positive Gram stain or culture
• pleural fluid glucose<40 milligrams/dL
• pH <7.2, or
• lactate dehydrogenase >1000 IU/L

Question 3

What is the definitive treatment of an empyema

Answer 3

Drainage and antibiotics (+ treatment of underlying cause)

Question 4

Most antibiotics have adequate penetration into the pleural space with the exception of what drug class

Answer 4

aminoglycosides

Question 5

Antibiotic options for Anaerobes (Emypema)

Answer 5

ß-lactam with
ß-lactamase activity, such as piperacillin-tazobactam or ampicillin-sulbactam,
a carbapenem, or clindamycin

Question 6

Antibiotic option for gram negative AEROBIC pathogens in Empyema

Answer 6

second- or third-generation cephalosporin plus metronidazole, a carbapenem, or a ß-lactam aminopenicillin with ß-lactamase activity

Question 7

Reasons for Medical Treatment Failure in Lung Abscess

Answer 7

• Bronchial obstruction: neoplasm, foreign body
• Nonbacterial cause: neoplasm, fungi, vasculitis, pulmonary sequestration
• Large cavity size: >6 cm diameter
• Empyema
• Mycobacteria

Question 8

Antibiotic therapy for Lung abscess

Answer 8

Ampicillin - Sulbactam 3 grams IV every 6 hours, or a carbapenem (Imipenem, Meropenem)

Question 9

in Lung Empyema, Drainage usually occurs spontaneously from communication of the abscess cavity with the tracheobronchial tree. This is signaled by the development of _____ on the chest radiograph

Answer 9

air fluid level