Lung abscess

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A 60 yr old alcoholic with poor dentition presented with cough productive of copious purulent sputum and fever.

1.    What is your diagnosis?

        Lung abscess

2.    List the key histopathological features.

       Suppurative destruction of lung parenchyma

       Central area of cavitation filled with pus (neutrophils, necrotic tissues,         inflammatory exudates: fluid component)

3.    What is the characteristic radiologic finding on chest X-ray?

        Air fluid levels in cavities

        Anaerobic abscesses are located in dependent, poorly ventilated and poorly   drained bronchopulmonary segments (lower lobes)

4.    What are the routes and possible pathogenic mechanism for this type of lung lesions?

    Aspiration of infective material

    �      Oral cavity

    �      Gastric contents

                Post infection (post-penumonia)

                Septic embolism: haematogenous spread

    �      Bacterial endocarditis

    �      Thrombophlebitis

    Obstruction � secondary infection (obstruction brought abt by neoplasm, foreign  material)

    Others

    �      Direct penetrating injury

    �      Spread of infection from neighbouring organs

    �      Haematogenous seeding of pyogenic bacteria

    Primary cryptogenic

5.    Cite some complications that may result.

       Extension of infection into pleural cavity (empyema)

       Purulent pericarditis

       Haemorrhage

       Septi emboli

     �      Brain abscess

     �     Meningitis

       Reactive secondary amyloidosis (rarely)

       Note: Pulmonary abscesses are usually single and usually occur at the right    lung because the right bronchus is more vertical.  Abscesses caused by bronchiectasis and also pneumonia are frequently multifocal.

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Copyright � Joseph Ong 2003