Dr Shweta Jha
ABSTRACT: Lung abscess is one of the major suppurative pleuro-pulmonary diseases, the other two being bronchiectasis and empyema thoracis.
It continues to cause significant morbidity and mortality despite considerable advances made in the diagnosis and its management.
KEYWORDS: Suppurative, bronchiectasis, pleuro-pulmonary, empyema thoracis, periodontal, aspiration, necrotizing, pneumonia, sarcoidosis, egophony
INTRODUCTION: Lung abscess is a localised area of necrosis of lung tissue with suppuration. It is of two types:
- Primary lung abscess that develops in an otherwise normal lung (e.g. aspiration of infected material).
- Secondary lung abscess that develops as a complication of some other disease of the lung or another site.
- Lung abscess is a circumscribed collection of purulent and necrotic material (pus) within the lung parenchyma.
- It is a necrotizing lung infection characterised by pus-filled cavitary lesion
- Microbial infection of the lungs leads to necrosis of the pulmonary tissue and formation of cavities containing necrotic debris or fluid.
- Frequency – most in patients having a predisposition to either aspiration or systemic/ local immune suppression
- Sex – male predominance
- Age – more common in elderly patients due to increased incidence of periodontal disease and increased prevalence of dysphagia and aspiration
- The formation of multiple small (<2cm) abscesses is occasionally referred to as necrotizing pneumonia or lung gangrene
- Duration defines the infection as acute versus chronic, with the dividing line usually 4 – 6 weeks.
- Aspiration of infected foreign material;
- Preceding bacterial infection
- Bronchial obstruction
- Septic embolism
- Infection in pulmonary infarcts
- Trauma to lungs
- Direct extension from a suppurative focus in mediastinum
- Factors predisposing to aspiration
- Impaired consciousness
- Oesophageal disorders
- Immune- suppression
- Chronic lung disease
- Diabetes mellitus
- Mechanical bronchial obstruction
- Aerobic organisms
- Anaerobic organisms
NON- INFECTIOUS CAUSES:
- Lung cancer
- Pulmonary embolism
- Lung infarction
- Productive cough
- Night sweats
- Weight loss
- Purulent, foul-smelling sputum
- Temperature ≥ 38◦C
- Crackles over affected area
- Chest X-Ray
- CT – Scan
- Anaerobic – sputum (putrid)
- Empyema – pleural fluid
- Aerobic – bronchoscopic aspirates
- Recurrent haemoptysis
- Metastatic abscesses
RUBRICS FOR LUNG ABSCESS:
- SYNTHESIS REPERTORY
- CHEST – ABSCESS – Lungs – accompanied by – Lungs; inflammation of
- CHEST – INFLAMMATION – Lungs – chronic – accompanied by – Lungs; abscess of
- CHEST – ABSCESS – Lungs – left
- CHEST – ABSCESS – Lungs
- CHEST – SUPPURATION of lungs
- HOMOEOPATHIC MATERIA MEDICA AND REPERTORY DR. WILLIAM BOERICKE
- RESPIRATORY SYSTEM – LUNGS, Abscess
- RESPIRATORY SYSTEM – CHEST, Affection, after operation, for hydrothorax, empyema
- MURPHY’S REPERTORY
- CHEST – ABSCESS, sensation of, on left, between pectoralis major and minor, hard and sensitive to touch, drawing pains in every direction, worse on motion of arm
- LUNGS – ABSCESS, lungs
- LUNGS – ABSCESS, alcoholics, in
- LUNGS – ABSCESS, left
- LUNGS – ABSCESS, thirst, with
- COMPLETE REPERTORY
- CHEST – ABSCESS – general – lungs
- CHEST – ABSCESS – general – lungs, left
- CHEST – ABSCESS – general – lungs, cancerous affections, in
- CHEST – ABSCESS – general – lungs, drunkards, in
- CHEST – ABSCESS – general – lungs, thirst, with
- CHEST – ABSCESS – general – lungs
- PHATAK’S REPERTORY
- CHEST AND LUNGS – abscess of lung
- ROBERTS H. REPERTORY
- INTERNAL CHEST – Suppurating behind sternum
- WARD J., REPERTORY
- CLINICAL – Abscess pectoral
- PULFORD A. and T.D., REPERTORY OF PNEUMONIA
- CHEST – abscess lungs
Lung abscess is a necrotizing lung infection characterised by a pus-filled cavitary lesion, and is most commonly caused by aspiration of oral secretions by patients who have impaired consciousness, with a male predominance and an older age group. Diagnosis is based primarily on chest x-ray. It is also important to distinguish lung abscess from similar conditions like necrotizing pneumonia, wherein, the former implies a cavity of at least 2cm in diameter, and the latter represents multiple, small cavities each of which is less than 2cm in diameter.
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Dr Shweta Jha
PG Scholar In Dept Of Practice Of Medicine
Father Muller Homoeopathic Medical College And Hospital, Mangalore