Pneumonia with lung abscess

Causes and Risks:
Aspiration of foreign material (often the stomach contents) into the lung can be a result of disorders that affect normal swallowing, disorders of the esophagus ( esophageal stricture , gastroesophageal reflux ), or decreased or absent gag reflex ( in unconscious , or semi-conscious individuals). Old age, dental problems, use of sedative drugs, anesthesia, coma , and excessive alcohol consumption are also causing or contributing factors. The response of the lungs depends upon the characteristics and amount of the aspirated substance. The more acidic the material, the greater the degree of lung injury. Aspiration of gastric contents is one of the leading causes of adult respiratory distress syndrome (flooding of the lungs with fluid).

The injured lungs can become infected with multiple species of anaerobic bacteria or aerobic bacteria . A collection of pus, from white blood cells that have been carried to the area to fight infection and from the microorganisms causing the infection, forms in the lung. A protective membrane may form around the abscess . The incidence of pneumonia with lung abscess is 6 out of 100,000 people.

Prevention:



Symptoms:

Additional symptoms that may be associated with this disease:



Signs and Tests:
Physical examination reveals crackling sounds with stethoscope.

These tests also help diagnose this condition:



Treatment:
Hospitalization is usually required for management of the illness. Treatment measures vary depending on the severity of the pneumonia . The objective of treatment is to control the infection by antibiotic therapy until improvement in chest X-ray is demonstrated.

Intubation of the airway (endotracheal tube passed through the nose or mouth through the trachea) may be required to keep the airway open and to deliver oxygen directly to the lungs. Mechanical ventilation (a respirator) may be used in the critically ill who cannot breathe adequately on their own. The ventilator attaches directly to the endotracheal tube. Air and oxygen are delivered to the patient by hoses connected to the ventilator according to the need of the patient. As improvement occurs, a patient is gradually weaned from the machine.

Suctioning of secretions that build up in the lungs via mouth or endotracheal tube is necessary to keep the airway clear.

Medications such as antibiotics to treat infection and bronchodilators to keep the airway open are often indicated.

Chest tube placement to drain the infection from the pleural space may be necessary to control the infection.

Prognosis:
The outcome depends on the severity of the pneumonia . If acute respiratory failure develops, the patient may have a prolonged illness or die. Healing may take as long as 6 to 12 months.

Complications:



Call Your Healthcare Provider:
Call your health care provider, go to the emergency room, or call the local emergency number (such as 911) if shortness of breath , wheezing , chills, fever, or fainting spells occur.


This picture shows the organism Pneumococci. These bacteria are usually paired (diplococci) or appear in chains. Pneumococci are typically associated with pneumonia, but may cause infection in other organs such as the brain (pneumococcal meningitis) and blood stream (pneumococcal septicemia). (Courtesy of the Centers for Disease Control.)



Bronchoscopy is a surgical technique for viewing the interior of the airways. Using sophisticated flexible fiber optic instruments, surgeons are able to explore the trachea, main stem bronchi, and some of the small bronchi. In children, this procedure may be used to remove foreign objects that have been inhaled. In adults, the procedure is most often used to take samples of (biopsy) suspicious lesions and for culturing specific areas in the lung.



This is an illustration of the major features of the lungs and bronchial tree. The inset is of the alveoli. They are the microscopic blood vessel-lined sacks in which oxygen and carbon dioxide gas are exchanged.



This chest X-ray shows the affects of the fungal infection, coccidioidomycosis. In the middle of the left lung (seen on the right side of the picture) there are multiple, thin-walled cavities (seen as light areas) with a diameter of 2 to 4 centimeters. To the side of these light areas are patchy light areas with irregular and poorly defined borders. Diseases that may explain these X-ray findings include lung abscesses, chronic pulmonary coccidioidomycosis, chronic pulmonary tuberculosis, chronic pulmonary histoplasmosis, and others.