1. Surgical Infections of Thorax
Infection----It is the invasion of
the body by pathogenic micro-
organisms and the reaction of the
tissues(inflammation) to their
presence and to the toxins
produced by them
2. PATHOLOGY
• Once the Infection has occurred ,it may:
1.Resolve
• 2.Cause Local Tissue Necrosis(Damage)
• 3. Spread in to the Body---
• a)Direct spread.
• b)Lymphatic spread.
• c)Haematogenous spread
• 4. Or become Chronic
3. GENERAL INVESTIGATIONS
• BLOOD---Acute infections are usually
characterised by POLYMORPHONUCLEAR
LEUCOCYTOSIS, while Chronic Infections by
LYMPHOCYTOSIS
• BLOOD CULTURE is usually positive in
Bacteraemia, Septicaemia and Pyaemia
• Discharge if present can be subjected to C/S Exam
• Other investigations depend upon site of
infection,e.g. radiography in bone
osteomyelitis,CT scan in Mediastinal Abscess&
USG in Lung or Chest Wall Abscess
4. GENERAL TREATMENT
• Antibiotics and conservative Rx--- Resolution
may be there
• When Abscess ---
• 1.Aspiration
• 2. Inscision and Drainage of Pus,
• 3. Slough is excised
• C/S report ----Specific Antibiotics
• Later Repair of the defects may be required
5. CLASSIFICATION OF INFLAMMATORY
DISEASES OF THORAX
A.INFECTIONS OF THE CONTAINER
B. INFECTIONS OF THE CONTENTS
A. CONTAINER:
1. SKIN
2.S/C TISSUE
3. I/C MUSCLES
4.I/C NERVES AND VESSELS
5. PARIETAL PLEURA
6.DIAPHRAGM
10. TUBERCULOSIS OF RIBS
• Tuberculosis is the most common
inflammatory lesion of the ribs, second
only to metastatic neoplasm as a
destructive cause of a rib lesion.
• IN retrospectively analyzed CT findings of
13 lesions in eight patients with
pathologically proven rib tuberculosis.
The presenting symptoms were:
11. SYMPTOMS
• painful mass in five,
• chest pain in two,
• and non tender mass in one.
• Five patients had concomitant
pulmonary tuberculosis.
12. INVESTIGATIONS
• On CT, all showed a juxta costal soft tissue
mass with central low attenuation and
peripheral rim enhancement (a so called «cold
abscess»).
• Only 4 of 13 lesions demonstrated bone
destruction: two were osteolytic expansile
lesions with cortical disruption and two were
mild cortical irregularities
14. TREATMENT OF TUB RIBS
• ATT
• DEPENDING ON THE RESPONSE
• FURTHER SURGICAL TREATMENT WILL
DEPEND .
15. ACTINOMYCOSIS THORAX
• There are two peak age periods of
actinomycotic infection: 11-20 year old
and 30-50 year old.
• Men are affected three times as often as
women.
• Only 27% of actinomycotic infections occur in
people under 20 years old
16. ACTINOMYCOSIS
• There are three major clinical forms of
• actinomycosis-
• the cervicofacial,
• thoracic and
• abdominopelvic.
• The thoracic form accounts for about 15% of cases,
• the cervicofacial form for about 55% and abdominal
form for about 20%.
• Infection of other organs including skin, brain,
pericardium and extremities accounts for 10% of
cases
17. • Pulmonary actinomycosis is most common in
patients with alcoholism and chronic
obstructive
lung disease.
• The primary location involves the
peribronchial tissue, bronchioles and alveola,
• its organisms may spread from lung to pleura,
ribs, spine, heart, pericardium and chest wall
• without regards for tissue plane and
boundaries The reason may relate to the
proteolytic activity of the bacteria.
18. ACTINOMYCOSIS
• The thorax is involved in approximately 13-15
per cent of all cases of actinomycosis
• Thoracic disease may occur by means of direct
extension from the cervicofacial and
abdominopelvic regions
19. • The presence of a chronic pleural
effusion with underlying lung
changes
and periosteal rib involvement is
a well recognized mode of
presentation and is usually
accepted as a diagnostic triad.
20. • bronchial brush biopsy may
prove more helpful where
there is doubt as to the
diagnosis.
21. Treatment
• PENICILLIN IS DRUG OF CHOICE
• 10-20 million units I/M for 2-3 weeks and
then Oral Penicillin V 500 mg 4 times a day
• OR
• SULPHONAMIDES e.g. Sulfamethoxazole 2-4
gm daily in divided doses
• Continued for many months till the S/S
disappear
• SURGERY---I/D or LOCAL DEBRIDEMENT
22. EMPYEMA
There are no universally accepted
guidelines for management of
empyema thoracic .
23. Definition
• presence of pus or microorganism in the pleural
fluid. Microorganisms may be seen on smear
examination or on culture.
• In the absence of microorganism,
– The pH of pleural fluid is less than 7.0
– Lactic dehydrogenase (LDH) is more than 1000 IU/L
– glucose is less than 40 mg/dl
– lactate is more than 5 mol/L or 45 mg/ml
24. Organisms
• Staphylococcus aureus, Streptococcus pneumoniae and
Streptococcus pyogenes
• Pneumococcal pneumonia presents with effusion in 40%
patients, empyema occurs only in 5%
• Anaerobes and enterobacter are common in mixed
infections. Anaerobes are more common after 6 years of
age. For anaerobes, aspiration pneumonia is the most
common cause followed by lung abscess, sub diaphrag-
matic abscess and spreading infection from adjacent
sites, e.g. periodontal, retropharyn-geal, peritonsillar and
neck abscesses.
• Tuberculous
25. Stages of Empyema
• Exudative stage (1-3 days )
• Fibrino purulent stage (4 to 14 days)
• Organizing stage (after 14 days)
26. Exudative stage (1-3 days)
• Immediate response with outpouring of the fluid.
• Low cellular content
• It is simple parapneumonic effusion with normal
pH and glucose levels.
– pH more than 7.30
– glucose more than 60 mg/dl
– pleural fluid/serum glucose ratio more than 0.5
– LDH less than 1000 IU/L
– Gram stain and culture is negative for micro-
organism.
27. Fibrino purulent stage (4 to 14 days)
• Large number of poly-morphonuclear leukocytes and
fibrin accumulates
• Fluid pH and glucose level fall while LDH rises.
• Acumulation of neutro-phils and fibrin, effusion becomes
purulent and viscous leading to development of
empyema.
• There is progressive tendency towards loculations and
formation of a limiting membranes.
• Pleural fluid analysis
– Purulent fluid or pH less than 7.10, glucose less than 40 mg/dl
and LDH more than 1000 IU/L. Gram stain and culture reports
show microorganism.
28. Organizing stage (after 14 days)
• Fibro-blasts grow into exudates on both the visceral
and parietal pleural surfaces
• Development of an inelastic membrane "the peel".
• Thickened pleural peel may prevent the entry of
anti-microbial drugs in the pleural space and in
some cases can lead to drug resistance.
• Most common in S. aureus infection.
• Thickened pleural peel can restrict lung movement
and it is commonly termed as trapped lung
29. CXR
• Large pleural effusion can be diagnosed in
posteroanterior view
• Lateral decubitus view with affected side
inferior facilitates recognition of smaller
volumes of fluid.
• X-ray in different positions helps to
recognize the extent of parenchymal
infection and may reveal loculated fluid
30. USG
• Very useful tool for diagnosis, guidance of thoraco-
centesis, or pleural catheter placement.
• Sonography can distinugish solid from liquid pleural
abnormalities with 92% accuracy compared to 68%
accuracy with chest X-ray. When both are combined,
accuracy rises to 98%
• USG shows limiting membranes suggesting the
presence of loculated collections even when they are
invisible by CT scan.
31. Thoracocentesis and Pleural Fluid Analysis
• If effusion is free flowing and greater than one
centimeter from inside of the chest wall to the
pleural fluid line on the lateral decubitus view,
immediate diagnostic thoracocentesis should be
done.
• If loculated, thoracocentesis should be done
under ultrasound guidance. The site for
thoracocentesis is 1 cm below upper level of
dullness
32. Thoracocentesis and Pleural Fluid Analysis
• Two third of the cases of anaerobic infection have malodorous
empyema
• Protein level and specific gravity is rarely helpful in differentiating
stages of empyema
• In some cases with frank pus, organisms are neither seen on Gram
stain nor grown in culture. Such cases must raise a suspicion of
chylous effusion
• cell fragments will sediment where a chylous effusion will remain
opaque after centrifugation
• Tuberculous empyema can be confirmed by stains for acid fast
bacilli in fewer than 25% cases but pleural biopsy and culture can
diagnose more than 90% cases
• ADA more than 70 U/L supports the diagnosis of tuberculous pleural
empyema
• PCR
33. Goal of treatment
1. Control of infection
2. Drainage of pus
3. Expansion of lungs
35. Emperical antibiotics
• Anti Staph antibiotic + Cephalosporin +
Aminoglycoside
• Suspectedanaerobic infection
Clindamycin should be added
36. Antibiotics
• Paren-teral therapy should be continued for 48-
72 hours after abatement of fever and then oral
therapy can be used to complete the course.
• Antibiotic should be continued until patient is
afebrile, WBC count is normal, radiograph show
consider-able clearing
• Duration of therapy
– H. influnezae, S. pneumonia: 10-14 days
– Staph aureus: 3-4 weeks
37. TUBE THORACOSTOMY
• Tube thoracostomy is usually
the first step in the treatment
of acute empyema. The
success rate for tube
thoracostomy is 70-85%
38. TUBE THORACOSTOMY IN LATE CASES
• Despite the expected low success
rate for tube thoracostomy in the
treatment of late empyema, it
remains a first line therapy, if for no
other reason than to attempt to
decrease the severity of pleural
sepsis until further therapy can be
instituted.
39. FIBRINOLYTIC THERAPY
• The use of fibrinolytic
therapy is associated with
resolution of empyema
thoracis in many cases
40. VAT
• VEDIO ASSISTED
THORACOSCOPIC DEBRIDEMENT
(VAT) debridement has achieved
satisfactory results in the
management of empyema in the
literature.
41. RIB RESECTION
• Rib resection and insertion of
large bore drain is another
successful method
42. • This can only be achieved when a large bore
tube is placed accurately in the most
dependent part of the collection for a
sufficient duration before organization
occurred.
43. DECORTICATION
• Decortication represents the most invasive
treatment for organized empyema cavities.
Decortication allows a more rapid recovery
with a decreased number of chest tube days,
and decreased length of hospital stay.
44. THORACOPLASTY
• Thoracoplasty was a common procedure in
the pre chemotherapeutic era of pulmonary
tuberculosis. It plays an important but less
prominent role in the treatment of
tuberculosis and has relevance in non-
tuberculous empyemas
45. MORTALITY
• For all stages, mortality rate
may be as high as 10% in
healthy patients and 50% in
elderly or debilitated patients
46. Bronchopleural fistula
• ICTD
• Decortication and fistula closure: after 2-3 weeks
of ICTD
• Gradual tube withdrawal
• Thoracoplasty or resectional surgery
• Response depends on
– Size of fistula,
– state of underlying lung and contralateral lung,
– presence or absence of systemic illness,
– nutritional rehabilitation
47. LUNG ABSCESS
• Lung abscesses are considered acute or
chronic depending on the duration of
symptoms at the time of patient
presentation.
• The arbitrary dividing time is 4-6 weeks.
• Primary lung abscess are commonly
observed in patients who are
predisposed to aspiration or in otherwise
healthy individuals,
48. • whereas secondary lung
abscesses represent
complications of a pre existing
local lesion such as a
bronchogenic carcinoma or a
systemic disease (eg, HIV
infection) that compromises
immune function
49. ETIOLOGY
• Lung abscesses have numerous infectious causes.
• Anaerobic bacteria continue to be accountable
for most cases. These bacteria predominate in
the upper respiratory tract and are heavily
concentrated in areas of oral-gingival disease.
• Other bacteria involved in lung abscesses are
gram-positive and gram-negative organisms.
However, lung cavities may not always be due to
an underlying infection.
53. PATHOGENESIS
• Aspiration of infectious material is the most frequent
etiologic mechanism in the development of pyogenic
lung abscess.
• Aspiration due to dysphagia (eg, achalasia) or to
compromised consciousness (eg, alcoholism, seizure,
cerebrovascular accident, head trauma) appears to
be a predisposing factor.
• Poor oral hygiene,
• dental infections,
• and gingival disease are also common in these
patients.
54. • Although lung abscesses can occur in edentulous
patients, an occult carcinoma should be
considered. Edentulous patients very seldom, if
ever, develop a putrefied abscess because they
lack periodontal flora.
• Patients with alcoholism and those with chronic
illnesses frequently have oropharyngeal
colonization with gram-negative
bacteria, especially when they undergo
prolonged endotracheal intubation and are
administered agents that neutralize gastric
acidity.
• A pyogenic lung abscess can also develop from
aspiration of infectious material from the
oropharynx into the lung when the cough reflex is
suppressed in a patient with gingivodental
disease.
55. PATHOLOGY
• Abscesses generally develop in the right lung and
involve the posterior segment of the right upper lobe,
the superior segment of the lower lobe, or both.
• This is due to gravitation of the infectious material
from the oropharynx into these dependent areas.
• Initially, the aspirated material settles in the distal
bronchial system and develops into a localized
pneumonitis.
• Within 24-48 hours, a large area of inflammation
results, consisting of exudate, blood, and necrotic lung
tissue. The abscess frequently connects with a
bronchus and partially empties.
56. • After pyogenic pneumonitis develops in response
to the aspirated infected material,
• liquefactive necrosis can occur secondary to
bacterial proliferation and an inflammatory
reaction to produce an acute abscess.
• As the liquefied necrotic material empties
through the draining bronchus, a necrotic cavity
containing an air-fluid level is created.
• The infection may extend into the pleural space
and produce an empyema without rupture of the
abscess cavity.
• The infectious process can also extend to the hilar
and mediastinal lymph nodes, and these too may
become purulent
57. Bacteriology of lung abscess
• Gram-negative organisms
–Bacteroides species
–Fusobacterium species
–Proteus species
–Aerobacter species
–Escherichia coli
58. • Gram-positive organisms
– Peptostreptococcus species
– Microaerophilic streptococcus
– Clostridium species
– Staphylococcus species
– Actinomyces species
• Opportunistic organisms
– Candida species
– Legionella species
– Mycobacterium species
59. Clinical Features
• have had symptoms for at least 2 weeks
• intermittent febrile course, productive
cough, weight loss, general malaise, and night
sweats. Initially.
• foul sputum is not observed in the course of
the infection; however, after cavitation
occurs, putrid expectorations are quite
prevalent.
60. • The odor of the breath and
sputum of a patient with an
anaerobic lung abscess is often
quite pronounced and noxious
and may provide a clue to the
diagnosis.
• Hemoptysis may occasionally
follow the expectoration of putrid
sputum.
61. • Primary lung abscesses that occur following
staphylococcal suppurative pneumonia in
infants and children lack the typical indolent
recurrent course of the more common
postaspiration infections.
• Their onset tends to be abrupt and more
threatening, producing :
• chills, fever, tachycardia, tachypnea, and
unremitting production of putrid sputum.
• Auscultation may reveal coarse rhonchi and
absent breath sounds.
• Clubbing of the fingers is sometimes noted.
62. Clinical Types
• Anaerobic necrotizing pneumonia
• Usually, anaerobic necrotizing pneumonia is chiefly
restricted to one pulmonary segment or lobe, although it
may progress to encompass an entire lung or both lungs.
• This type of anaerobic lung infection is the most serious.
• The inflammatory process often spreads quickly and
causes destruction characterized by greenish staining of
the lung and a huge amount of putrid tissue, resulting in
pulmonary gangrene.
• These patients are gravely ill with a progressive septic
course.
• Leukocytosis is obvious, and the sputum is putrid.
63. • Secondary lung abscess
• In cases of secondary lung abscess, the
fundamental process (eg, bacteremia,
endocarditis, septic thrombophlebitis, subphrenic
infection) is generally apparent along with the
pulmonary pathology.
• Infections below the diaphragm may extend to
the lung or pleural space by way of the
lymphatics, either directly through the diaphragm
or via defects in it.
• The most typical hematogenous lung abscesses
are observed in persons with staphylococcal
bacteremia, especially in children.
64. • These abscesses are multiple and are located in the
periphery of the lung.
• Infections may arise in or posterior to an obstruction
(eg, an enlarged mediastinal lymph node) and migrate
to the lungs.
• Septic emboli from bacterial endocarditis or emboli
from deep pelvic veins may result in metastatic lung
abscess.
• Septic emboli are suggested when multiple lesions
appear over an extended period.
• Fewer than 5% of bland pulmonary infarcts become
secondarily infected.
• Secondary infection of infarcts is suggested if fever and
leukocytosis are present. Abscess formation may also
occur within a necrotic pulmonary tumor.
65. Amoebic lung abscess
• Patients who develop an amoebic lung abscess
often have symptoms associated with a liver
abscess.
• These may include right upper quadrant pain and
fever.
• After perforation of the liver abscess into the
lung, the individual may develop a cough and
expectorate a chocolate or anchovy paste–like
sputum that has no odour.
• The patient may give a history of diarrhoea and
travel outside the country
66. Chest radiographs
• The distinctive characteristic of lung abscess,
the air-fluid level, (2weeks)can only be
observed on a chest x-ray film taken with the
patient upright or in the lateral decubitus
position. In the presence of associated pleural
thickening, atelectasis, or pneumothorax, the
air-fluid level may be obscured. When better
anatomic interpretation is required, CT scans
have proven very useful.
67. CT SCAN
• Chest CT scan images are valuable for
demonstrating cavitation within an area of
consolidation,
• for evaluating the thickness and regularity of the
abscess wall,
• and for determining the exact position of the
abscess with regard to the chest wall and
bronchus.
• CT scan images can also aid in evaluating the
extent of bronchial involvement proximal or distal
to the abscess.
68. Invasive diagnostic procedures
• transtracheal aspirates,
• transthoracic aspirates,
• and fiberoptic bronchoscopy
• TO BE DONE prior to the institution of
antibiotic therapy
• benefits of such procedures are controversial
• Not Routinely but only for Atypical cases
69. Differential diagnosis
• Differential diagnoses of a cavitary lung lesion
• Anaerobic infection
– Gram-negative bacteria
– Pseudomonas species
– Legionella species
– Haemophilus influenzae species
• Gram-positive bacteria
– Staphylococcus species
– Streptococcus species
– Mycobacterium species
– Fungi
70. • Parasitic
– E histolytica
– Paragonimus westermani
• Septic
– Embolism
– Cavitary infarction
– Bland infarction
– Wegener vasculitis
– Neoplasms
– Bronchogenic carcinoma
– Metastatic carcinoma
– Lymphoma
• Sequestration
– Bulla with fluid
– Empyema with air fluid levels
72. • Gram-negative organisms
• First choices – Cephalosporins,
aminoglycosides, quinolones
• Alternatives – Penicillines and cephalexin
(Bio cef)
• Oral therapy - Trimethoprim/sulfa methoxa
zole (Septran)
• Pseudo monal organisms: First choices
include aminoglycosides, quinolones, and
cephalosporin
73. • Gram-positive organisms
–First choices - Oxacillin (Bactocill),
clindamycin, cephalexin, nafcillin
(Nafcil), and amoxicillin
–Alternatives - Cefuroxime (Ceftin) and
clindamycin
–Oral therapy - Vancomycin (Lyphocin)
• Nocardial organisms: First choices
include trimethoprim/sulfamethoxazole
and tetracycline (Sumycin).
74. DRAINAGE
• Most lung abscesses communicate with the
tracheo bronchial tree early in the course of
the infection and drain spontaneously
during the course of therapy.
• Dependent drainage (with appropriate
positions based on the pulmonary segment)
is commonly advocated using chest physical
therapy and sometimes broncho scopy.
• .
75. • Bronchoscopy can also facilitate
abscess drainage by aspiration of the
appropriate bronchus through the
bronchoscope.
• Transbronchial drainage by
catheterization of the appropriate
bronchus under fluoroscopy has
been successful
76. • Generally, augmenting this passive drainage
with invasive procedures is unnecessary.
• In fact, attempts at therapeutic bronchoscopy
may sometimes produce adverse
consequences.
• Reports have been received of bronchoscopy-
induced release of large amounts of purulent
material from the involved lung segment into
other parts of the lung,
• occasionally inducing acute respiratory
failure, acute respiratory distress syndrome
(ARDS), or both.
77. • Course of treatment
• If treatment is started in the acute stage of the disease and is
continued for 4-6 weeks,
• approximately 85-95% of patients with anaerobic lung
abscesses respond to medical management alone. Successful
medical therapy resolves symptoms with no radiographic
evidence or only a residual thin-walled cystic cavity (<2 cm after
4-6 wk of antibiotic therapy).
• The success of medical therapy is dependent on the duration of
symptoms and the size of the cavity before the initiation of
therapy.
• Antibiotic therapy is rarely successful if symptoms are present
for longer than 12 weeks before the initiation of antibiotic
therapy or if the original diameter of the cavity is more than 4
cm.
• When patients with lung abscesses do not respond to proper
medical therapy, consider the probability of an underlying
malignancy.
78. SURGICAL TREATMENT
• Contraindications to surgery
• Several important factors must be considered
prior to undertaking surgery.
• Because of the high risk of spillage of the abscess
into the contra lateral lung, it is almost essential
that a double-lumen tube be used to protect the
airway.
• If this is not available, surgery poses a very high
risk of abscess in the other lung and a risk of
ARDS.
.
79. • In such cases, postponing the surgery is a wise
decision.
• Another, less-satisfactory method to deal with
this problem includes positioning the patient in
the prone position.
• The surgeon must be skilled in resecting the
abscess and in rapid clamping of the bronchus to
prevent spillage into the trachea.
• These factors are extremely important when
dealing with the surgical aspects of treating a
lung abscess. If doubt persists, postponing the
surgery is best.
80. • Surgical treatment is now rarely
necessary and is almost never the initial
choice in the treatment of lung
abscesses.
• In current practice, fewer than 15% of
patients need surgical intervention for
the unchecked disease and for
complications that occur in both the
acute and chronic stages of the disease.
81. • Surgical management is reserved for
specific indications such as little or no
response to medical treatment, inability
to eliminate a carcinoma as a cause,
critical hemoptysis, and complications of
lung abscess (eg, empyema,
bronchopleural fistula).
• In addition, if after 4-6 weeks of medical
treatment a notable residual cavity
remains and the patient is symptomatic,
surgical resection is advocated
82. INDICATIONS OF SURGERY
• Probable carcinoma
• Significant hemoptysis
• Percutaneous drainage
• Percutaneous drainage of a complicated abscess
(ie, one associated with fever and signs of sepsis)
is beneficial in selected patients who do not
respond to adequate medical therapy. These are
ventilator-dependent patients who are not
candidates for extensive thoracic procedures.
83. • Other indications for drainage include
ongoing sepsis despite adequate
antimicrobial therapy,
• progressively enlarging lung abscess in
imminent danger of rupture,
• failure to wean from mechanical
ventilation, and contamination of the
opposite lung.
• In current practice, most of these lung
abscesses are drained under CT
guidance.
84. • Results achieved with percutaneous drainage
show it to be safe and effective compared to
surgery.
• Percutaneous drainage is rarely complicated by
empyema, hemorrhage, or bronchopleural
fistula.
• Although a few patients who undergo
percutaneous drainage develop bronchopleural
fistulas, most of these fistulas close
spontaneously with resolution of the abscess
cavity.
• Percutaneous drainage may be used to stabilize
and prepare critically ill patients for surgery
85. • Abscess from gram-negative and
opportunistic bacteria
• Hospital-acquired gram-negative infections
are usually due to nosocomial organisms (eg,
Pseudomonas, Enterobacter, Proteus). Patients
with these infections are often elderly,
debilitated with numerous major medical
disorders, or have sustained multiple trauma.
These patients are typically treated in a critical
care unit.
86. • The infection is usually with a resistant
organism originating from a single source.
The lung abscess appears rapidly as an area
of pneumonitis with associated pleural
involvement. These patients often require
per cutaneous drainage as an emergency
procedure. Unfortunately, the infection is
systemic and often out of control, and the
pulmonary pathology represents only one
aspect of a multi organ involvement with a
rapidly deteriorating course.
87. • Among fungal infections, Candida
albicans has become a major organism
in lung abscesses. Fungal infections are
difficult to treat, and
amphotericin/fluconazole and surgical
drainage remain the only modalities of
treatment; however, at best, they have
had only limited success.
88. COMPLICATIONS
• Approximately one third of lung abscesses are
complicated by empyema. This may be observed
with or without broncho- pleural fistulas.
Haemoptysis is a common complication of a lung
abscess and can be treated with bronchial artery
embolization. Occasionally, the haemoptysis can
be massive, thus requiring urgent surgery. Brain
abscess may also be a complication in patients
who receive inadequate treatment.
89. • Occasionally, the haemoptysis
can be massive, thus requiring
urgent surgery. Brain abscess may
also be a complication in patients
who receive inadequate
treatment
90. PROGNOSIS
• The prognosis of patients with lung abscesses
depends on the underlying or predisposing
pathologic event and the speed with which
appropriate therapy is established.
• Negative prognostic factors include a large cavity
(>6 cm), necrotizing pneumonia, multiple
abscesses, immuno compromise, age extremes,
associated bronchial obstruction, and aerobic
bacterial pneumonia.
91. • The mortality rate associated with an
anaerobic lung abscess is less than
15%, although it is slightly higher in
patients with necrotizing anaerobic
pneumonia and pneumonia caused
by gram-negative bacteria.
• The prognosis associated with
amoebic lung abscess is good when
treatment is prompt
