lung abscess

肺膿瘍

WordNet

1. either of two saclike respiratory organs in the chest of vertebrates; serves to remove carbon dioxide and provide oxygen to the blood
2. symptom consisting of a localized collection of pus surrounded by inflamed tissue
3. infected and filled with pus; "an abscessed tooth"

PrepTutorEJDIC

1. 《しばしば複数形で》『肺』,肺臓
2. 膿瘍(のうよう)(うんだできもの)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/10/04 17:00:43」(JST)

wiki en

[Wiki en表示]

Lung abscess
Computed tomography (CT) scan of chest showing bilateral pneumonia with abscesses, effusions, and caverns. 37-year-old male.
Classification and external resources
Specialty	pulmonology
ICD-10	J85
ICD-9-CM	513.x
DiseasesDB	7607
eMedicine	med/1332
MeSH	D008169

Lung abscess is a type of liquefactive necrosis of the lung tissue and formation of cavities (more than 2 cm) containing necrotic debris or fluid caused by microbial infection.

This pus-filled cavity is often caused by aspiration, which may occur during anesthesia, sedation, or unconsciousness from injury. Alcoholism is the most common condition predisposing to lung abscesses.

Lung abscess is considered primary (60%) when it results from existing lung parenchymal process and is termed secondary when it complicates another process e.g. vascular emboli or follows rupture of extrapulmonary abscess into lung.

Signs and symptoms

Onset of symptoms is often gradual, but in necrotizing staphylococcal or gram-negative bacillary pneumonias patients can be acutely ill. Cough, fever with shivering, and night sweats are often present. Cough can be productive of foul smelling purulent mucus (≈70%) or less frequently with blood in one third of cases). Affected individuals may also complain of chest pain, shortness of breath, lethargy and other features of chronic illness.

Those with a lung abscess are generally cachectic at presentation. Finger clubbing is present in one third of patients. Dental decay is common especially in alcoholics and children. On examination of the chest there will be features of consolidation such as localized dullness on percussion and bronchial breath sounds.

Causes

Conditions contributing to lung abscess

• Aspiration of oropharyngeal or gastric secretion
• Septic emboli
• Necrotizing pneumonia
• Vasculitis: Granulomatosis with polyangiitis
• Necrotizing tumors: 8% to 18% are due to neoplasms across all age groups, higher in older people; primary squamous carcinoma of the lung is the most common.

Organisms

In the post-antibiotic era pattern of frequency is changing. In older studies anaerobes were found in up to 90% cases but they are much less frequent now.

• Anaerobic bacteria: Actinomyces, Peptostreptococcus, Bacteroides, Fusobacterium species,
• Microaerophilic streptococcus : Streptococcus milleri
• Aerobic bacteria: Staphylococcus, Klebsiella, Haemophilus, Pseudomonas, Nocardia, Escherichia coli, Streptococcus, Mycobacteria
• Fungi: Candida, Aspergillus
• Parasites: Entamoeba histolytica,

Diagnosis

Imaging studies

Lung abscesses are often on one side and single involving posterior segments of the upper lobes and the apical segments of the lower lobes as these areas are gravity dependent when lying down. Presence of air-fluid levels implies rupture into the bronchial tree or rarely growth of gas forming organism.

Laboratory studies

Raised inflammatory markers (high ESR, CRP) are common but nonspecific. Examination of the coughed up mucus is important in any lung infection and often reveals mixed bacterial flora. Transtracheal or transbronchial (via bronchoscopy) aspirates can also be cultured. Fiber optic bronchoscopy is often performed to exclude obstructive lesion; it also helps in bronchial drainage of pus.

• Pulmonary abscess on CT scan

• Pulmonary abscess on CXR

• Pathology image of a lung abscess.

• A subpleural abscess.

Management

Broadspectrum antibiotic to cover mixed flora is the mainstay of treatment. Pulmonary physiotherapy and postural drainage are also important. Surgical procedures are required in selective patients for drainage or pulmonary resection.

Prognosis

Most cases respond to antibiotics and prognosis is usually excellent unless there is a debilitating underlying condition. Mortality from lung abscess alone is around 5% and is improving.

Complications

Rare nowadays but include spread of infection to other lung segments, bronchiectasis, empyema, and bacteremia with metastatic infection such as brain abscess.

See also

• Empyema
• Bronchiectasis
• Abscess
• Pleural effusion

References

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 肺膿瘍 lung abscess
• 2. 肺炎桿菌（肺炎クレブシエラ）感染症の臨床的特徴、診断、および治療 clinical features diagnosis and treatment of klebsiella pneumoniae infection
• 3. 小児における市中肺炎の臨床的特徴および診断 clinical features and diagnosis of community acquired pneumonia in children
• 4. 難治性肺炎 nonresolving pneumonia
• 5. 成人における嚥下性肺炎 aspiration pneumonia in adults

English Journal

• Colopleural fistula caused by aspergillus: an extremely rare complication after lung resection-case report.

• Hayashi A1, Susaki Y2, Ose N2, Takeuchi Y2, Maeda H2.
• Surgical case reports.Surg Case Rep.2016 Dec;2(1):40. doi: 10.1186/s40792-016-0167-0. Epub 2016 Apr 23.
• A colopleural fistula is a rare condition reported to be caused by Crohn's disease, a malignant tumor of the gastrointestinal tract, and other clinical conditions. Some studies have noted that a sub-diaphragmatic abscess, usually organized following abdominal surgery, may play some role in the forma
• PMID 27108124

• Community-associated Staphylococcus aureus pneumonia among Greek children: epidemiology, molecular characteristics, treatment, and outcome.

• Doudoulakakis AG1, Bouras D2, Drougka E3, Kazantzi M4, Michos A4, Charisiadou A2, Spiliopoulou I3, Lebessi E5, Tsolia M6.
• European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology.Eur J Clin Microbiol Infect Dis.2016 Jul;35(7):1177-85. doi: 10.1007/s10096-016-2651-7. Epub 2016 May 2.
• Staphylococcus aureus is an infrequent cause of community-associated (CA-SA) pneumonia in children. The aim of this study was to evaluate the clinical, epidemiological, microbiological, and molecular characteristics of CA-SA pneumonia among children hospitalized in two large tertiary care referral c
• PMID 27140201

• Disseminated tuberculosis after pregnancy progressed to paradoxical response to the treatment: report of two cases.

• Shinohara T1, Kagawa K2, Okano Y2, Sawada T3, Kobayashi T4, Takikawa M5, Iwahara Y6, Ogushi F2.
• BMC infectious diseases.BMC Infect Dis.2016 Jun 13;16(1):284. doi: 10.1186/s12879-016-1624-x.
• BACKGROUND: Early postpartum women are more likely to develop tuberculosis than nonpregnant women mainly due to immune reconstitution after delivery. Paradoxical response (PR) during antituberculosis treatment also arises via recovery from immunosuppression. However, no study focused on PR during an
• PMID 27297079

Japanese Journal

• Disseminated Nontuberculous Mycobacterial Infection in a Patient with Anti-IFN-γ Autoantibodies

• Acta Medica Okayama 71(6), 547-552, 2017-12
• NAID 120006370721

• 肺癌との鑑別を要したAggregatibacter actinomycetemcomitansによる肺膿瘍・胸壁浸潤を呈した健康成人の1例

• 呼吸器内科 = Respiratory medicine 32(4), 411-415, 2017-10
• NAID 40021369333

• 第90回日本感染症学会学術講演会座長推薦論文 Capnocytophaga感染症10例の検討

• 感染症学雑誌 = The journal of the Japanese Association for Infectious Diseases 91(3), 387-391, 2017-05
• NAID 40021233747

Related Links

• Lung Abscess: Definition and Patient Education

A lung abscess is a bacterial infection that occurs in the lung tissue. The infection causes tissue to die, and pus collects in that space. A lung abscess ... Lung abscesses can be classified as primary or secondary.

• Lung Abscess: Symptoms, Causes, Diagnosis, Treatment

A lung abscess is a pus-filled cavity in the lung that is caused by an infection. Learn what causes it, how to spot symptoms, and how doctors treat it.

• Lung Abscess: Background, Pathophysiology, Etiology

Lung abscess is defined as necrosis of the pulmonary tissue and formation of cavities containing necrotic debris or fluid caused by microbial infection. The formation of multiple small (< 2 cm) abscesses is occasionally ...

---

★リンクテーブル★

リンク元

「肺膿瘍」

「肺膿瘍」

　　[★]

英

lung abscess, pulmonary abscess

概念

• 肺化膿症の一つで、広義の肺炎である。　→　肺化膿症と同義に使われている印象がある。
• 肺実質の壊死を来たし、膿瘍・空洞を形成する。
• ニボー像が特徴的

病原体

• 嫌気性菌が最多。
• 黄色ブドウ球菌、クレブシエラ、大腸菌、緑膿菌も原因となる。

治療

• 薬物療法：病原体が特定されれば感受性のある抗菌薬を、不明であれば広域スペクトルの抗菌薬を用いる(セフェム系抗菌薬、クリンダマイシン、カルバペネム系抗菌薬)
• 外科療法：難治例に対して空洞切開術、肺葉切除

USMLE

• Q book p.289 8
• A patient develops an acute febrile illness with shivers, nonproductive cough, and pleuritic chest pain. Five days later, he presents to the emergency department after abruptly having "cough up" nearly a cup of blood-stained sputum.