Lung Abscess

Question 1

Represents necrosis and cavitation of the lung following microbial infection.

Answer 1

Lung abscess

Question 2

Lung abscesses can be single or multiple but usually are marked by a single dominant cavity ___

Answer 2

> 2 cm in diameter.

Question 3

Primary lung abscesses generally arise from aspiration, often are caused principally by ______, and occur in the absence of an underlying pulmonary or systemic condition.

Answer 3

anaerobic bacteria

Question 4

Acute Lung Abscess

Answer 4

<4-6 weeks

Question 5

Major risk factor for Lung abscess is __

Answer 5

Aspiration

Question 6

Patients at risk for Lung Abscess

Answer 6

1. Altered mental status
2. Alcoholism
3. Drug overdose
4. Seizures
5. Bulbar dysfunction
6. Prior cerebrovascular or cardiovascular events
7. Neuromuscular disease

Additional Risk factors:
-esophageal dysmotility or esophageal lesions (strictures or tumors)
-gastric distention
-gastroesophageal reflux
-spend substantial time in the recumbent position

Question 7

Pathogens: Primary Lung Abscess

Answer 7

Anaerobes
Microaerophilic streptococci

Question 8

Pathogens: Secondary lung abscess

Answer 8

Staphylococcus aureus
Gram-negative rods

Question 9

Pathogens: Embolic lesions

Answer 9

Staphylococcus aureus (Tricuspid valve endocarditis)
Fusobacterium necrophorum (Lemierre’s syndrome)

Question 10

Endemic infections

Answer 10

Mycobacterium tuberculosis
Coccidioides spp.
Histoplasma capsulatum
Blastomyces spp.
Parasites

Question 11

An infection that begins in the pharynx and then spreads to the neck and the carotid sheath to cause septic thrombophlebitis

Answer 11

Lemierre’s syndrome

Question 12

Most common locations of primary lung abscesses

Answer 12

Posterior Upper Lobe
Superior Lower Lobe

Question 13

When no pathogen is isolated from a primary lung abscess

Answer 13

Nonspecific lung abscess
(presence of anaerobes is often presumed)

Question 14

Cases with foul-smelling breath, sputum, or empyema

Answer 14

Putrid Lung Abscess

Question 15

Recommended regimen for Primary Lung Abscess

Answer 15

(1) Clindamycin (600 mg IV three times daily; then, with the disappearance of fever and clinical improvement, 300 mg PO four times daily)

(2) an IV-administered β-lactam/β-lactamase combination, followed—once the patient’s condition is stable—by orally administered amoxicillin-clavulanate.

Question 16

An abscess _______ is less likely to respond to antibiotic therapy without additional interventions.

Answer 16

> 6–8 cm in diameter

Question 17

Alternative procedure if patient is a poor surgical candidate

Answer 17

Percutaneous drainage of the abscess

Question 18

Mortality rate of Primary Lung Abscess

Answer 18

<2%

Question 18

Possible complications of percutaneous drainage include :

Answer 18

1. Bacterial contamination of the pleural
2. Pneumothorax
3. Hemothorax

Question 19

Mortality rate of Secondary Lung abscess

Answer 19

as high as 75%

Question 20

Poor prognostic Factors for Lung Abscess

Answer 20

1. Age >60 years old
2. Presence of aerobic bacteria
3. Sepsis at presentation
4. Symptom duration >8 weeks
5. Abscess size >6 cm

Question 21

Presents with a more fulminant course characterized by high fevers and rapid progression.

Answer 21

Non-anaerobic organisms (S. aureus)

Question 22

It takes ____ days before defervescence during treatment

Answer 22

7 days

Question 23

Duration of treatment for Lung Abscess

Answer 23

3-4 weeks, can extend to 14 weeks, until imaging has cleared/regressed to a small scar