Lung abscess differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Lung abscess}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Lung_abscess]]
{{CMG}};{{AE}}{{ADG}}
{{CMG}};{{AE}}{{ADG}}
==Overview==
==Overview==
Lung abscess must be differentiated from other cavitary lesions that cause cough, fever with chills and rigor and chest pain such as malignancy, tuberculosis, Wegener's granulomatosis, rheumatoid nodules.
Lung abscess must be differentiated from other lesions that present with similar symptoms such as [[cough]], [[fever]] with [[chills]] and [[rigor]] and chest includes [[malignancy]], pulmonary [[Tuberculosis, pulmonary|tuberculosis]], [[Wegener's granulomatosis]], [[rheumatoid nodules]].


==Differential diagnosis==
==Differential==




{| class="wikitable"
! rowspan="3" |Disease
! colspan="9" |Clinical features
Signs & symptoms
! rowspan="3" |Radiological Findings
! rowspan="3" |Characterstic feature
|-
| colspan="2" |Fever
| colspan="2" |Cough
| rowspan="2" |Hemoptysis
| rowspan="2" |Dyspnea
| rowspan="2" |Chest pain
| rowspan="2" |Weight loss
| rowspan="2" |Night sweats
|-
|High-grade
|Low grade
|Productive
|Dry   
|-
|Acute Lung abscess
| +
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* Air fluid level
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* Foul smelling [[sputum]]
* H/o of prior [[infection]] or [[hospitalization]]
* Associated with risk factors like [[aspiration]] and [[alcoholism]]
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|[[Malignancy]]
([[Lung cancer|primary lung cancer]])
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| +
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| +
| +
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| +
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* A coin-shaped lesion with thick wall(>15mm) is seen on chest x-ray with less ground glass opacities <sup>[[Lung abscess differential diagnosis|[2][3]]</sup>
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* Long H/o smoking
* Elderly male or female
* BAL positive for [[malignant]] [[cells]]
* CT guided [[biopsy]] is required for confirmation and differnatiation
|-
|[[Tuberculosis, pulmonary|Pulmonary Tuberculosis]]
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* Chest x-ray and CT demonstrates [[Internal|cavities]] in the upper lobe of the [[lung]]
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* People in [[Endemic (epidemiology)|endemic]] at high risk
* [[Cough]] >2 weeks with [[hemoptysis]]
* [[Acid fast|Acid fast stain]] positive for [[Mycobacterium|mycobacteria]]
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|[[Pneumonia|Necrotizing Pneumonia]]
| +
|
| +
|
| +
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| +
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* Multiple cavitary lesions
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* Acute life threatening condition
* Complication of [[pneumonia]] or lung abscess
* Multiple [[organisms]] responsible
* prompt treatment with [[antibiotics]] is required
* CBC positive for causative organism
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|[[empyema]]
| +
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| +
| +
| +
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* Homogeneous [[Consolidation (medicine)|consolidation]] involving one, or less commonly, multiple [[lobes]]
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* Blood culture positive for causative agent.
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|[[Bronchiectasis]]
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| +
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| +
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* Specific findings include linear lucencies  tram tracking appearance, clustered cysts.
* Increased [[pulmonary]] markings, honeycombing, [[atelectasis]] and pleural changes.
|High resolution CT helps in diagnosis .
|-
|[[Wegener's granulomatosis|Wegners granulomatosis]]
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| +
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* [[Pulmonary]] [[nodules]] with [[cavities]] and infiltrates
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* Seen mostly in female age group of 40-55 years
* Traid of Upper , lower respiratory tract and kidney disease
* Biopsy of involved [[Organ (anatomy)|organ]] confirms [[granulomas]]
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|[[Sarcoidosis]]
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* [[Bilateral]] [[Lymphadenopathy|adenopathy]] and coarse reticular opacities are seen on CXR
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* More common in African-american females
* [[Restrictive lung disease]]
** Biposy findings: [[epithelioid]],granuloma<nowiki/>s, schaumann<nowiki/>, asteroid bodies.
|-
|[[Rheumatoid nodule]]
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| +
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* [[Pulmonary]] [[nodules]] with cavitation are located in the upper lobe are seen on chest x-ray
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* [[Rheumatoid arthritis]]
* Positive for [[Rheumatoid factor|RF]] and ACP 
|-
|[[Langerhans cell histiocytosis|Langerhans cell Histiocytosis]]
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| +
| +
| +
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* Thin-walled cystic cavities on chest x-ray
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* Exclusively afflicts smokers.
* [[Musculoskeletal]] and [[skin]] is involved
* Biopsy of the involved organ
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|[[Bronchiolitis obliterans]]
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* Common appearance on CT is patchy [[Consolidation (medicine)|consolidation,]]<nowiki/>often accompanied by ground-glass opacities and nodules.
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* Occupational exposure of industrial toxins
* Restrictive type of lung disease
* Biopsy often confirms the diagnosis
|}
<br><br>
{| class="wikitable"
{| class="wikitable"
!Causes of
!Causes of
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*Malignancy (Primary lung cancer)<ref name="pmid4353362">{{cite journal |vauthors=Chaudhuri MR |title=Primary pulmonary cavitating carcinomas |journal=Thorax |volume=28 |issue=3 |pages=354–66 |year=1973 |pmid=4353362 |pmc=470041 |doi= |url=}}</ref>
*[[Malignancy]] ([[Lung cancer|Primary lung cance<nowiki/>r]])<ref name="pmid4353362">{{cite journal |vauthors=Chaudhuri MR |title=Primary pulmonary cavitating carcinomas |journal=Thorax |volume=28 |issue=3 |pages=354–66 |year=1973 |pmid=4353362 |pmc=470041 |doi= |url=}}</ref>
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*Elderly male or female <ref name="pmid4353362">{{cite journal |vauthors=Chaudhuri MR |title=Primary pulmonary cavitating carcinomas |journal=Thorax |volume=28 |issue=3 |pages=354–66 |year=1973 |pmid=4353362 |pmc=470041 |doi= |url=}}</ref>
*Elderly male or female <ref name="pmid4353362">{{cite journal |vauthors=Chaudhuri MR |title=Primary pulmonary cavitating carcinomas |journal=Thorax |volume=28 |issue=3 |pages=354–66 |year=1973 |pmid=4353362 |pmc=470041 |doi= |url=}}</ref>
*Presents with a low-grade fever, absence of leukocytosis, systemic complaints weight loss,fatigue.
*Chronic smokers
*Absence of factors that predispose to gastric content aspiration, no response to antibiotics within 10 days, 
*Presents with a [[low-grade fever]], absence of [[leukocytosis]], systemic complaints [[weight loss]], [[fatigue]]
*Hemoptysis is commonly associated with bronchogenic carcinoma
*Absence of factors that predispose to [[gastric content aspiration]], no response to [[antibiotics]] within 10 days  
*[[Hemoptysis]] is commonly associated with [[bronchogenic carcinoma]]
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*A coin-shaped lesion with thick wall(>15mm) is seen on X-ray with less ground glass opacities.<ref name="pmid8572761">{{cite journal |vauthors=Mouroux J, Padovani B, Elkaïm D, Richelme H |title=Should cavitated bronchopulmonary cancers be considered a separate entity? |journal=Ann. Thorac. Surg. |volume=61 |issue=2 |pages=530–2 |year=1996 |pmid=8572761 |doi=10.1016/0003-4975(95)00973-6 |url=}}</ref> <ref name="pmid16183941">{{cite journal |vauthors=Onn A, Choe DH, Herbst RS, Correa AM, Munden RF, Truong MT, Vaporciyan AA, Isobe T, Gilcrease MZ, Marom EM |title=Tumor cavitation in stage I non-small cell lung cancer: epidermal growth factor receptor expression and prediction of poor outcome |journal=Radiology |volume=237 |issue=1 |pages=342–7 |year=2005 |pmid=16183941 |doi=10.1148/radiol.2371041650 |url=}}</ref>
*A coin-shaped lesion with thick wall(>15mm) is seen on CXR with less ground glass opacities <ref name="pmid8572761">{{cite journal |vauthors=Mouroux J, Padovani B, Elkaïm D, Richelme H |title=Should cavitated bronchopulmonary cancers be considered a separate entity? |journal=Ann. Thorac. Surg. |volume=61 |issue=2 |pages=530–2 |year=1996 |pmid=8572761 |doi=10.1016/0003-4975(95)00973-6 |url=}}</ref> <ref name="pmid16183941">{{cite journal |vauthors=Onn A, Choe DH, Herbst RS, Correa AM, Munden RF, Truong MT, Vaporciyan AA, Isobe T, Gilcrease MZ, Marom EM |title=Tumor cavitation in stage I non-small cell lung cancer: epidermal growth factor receptor expression and prediction of poor outcome |journal=Radiology |volume=237 |issue=1 |pages=342–7 |year=2005 |pmid=16183941 |doi=10.1148/radiol.2371041650 |url=}}</ref>
*Bronchoalveolar lavage cytology shows malignant cells  
*[[Bronchoalveolar lavage]] [[cytology]] shows malignant cells  
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*Biopsy of lung  
*[[Biopsy]] of lung  
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|-
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*Tuberculosis  
*Pulmonary [[Tuberculosis, pulmonary|Tuberculosis]]
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*Any age group
*Mostly in endemic areas
*Symptoms include productive cough,night sweats ,fever and weight loss.
*Symptoms include [[productive cough]],[[night sweats]], [[fever]] and [[weight loss]]
|
|
*CXR and CT demonstrates cavities in the upper lobe of the lung.
*CXR and CT demonstrates [[Internal|cavities]] in the upper lobe of the lung
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*Sputum smear positive for acid-fast bacilli and culture in Lowenstein-Jensen media grows mycobacteria.
*[[Sputum]] smear positive for [[acid-fast bacilli]] and nucleic acid amplification tests (NAAT) is used on sputum or any sterile fluid for rapid diagnosis and is positive for mycobacteria.
|-
|-
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*Necrotizing Pneumonia
*[[Necrotizing Pulmonary Infections|Necrotizing]] [[Pneumonia]]
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*Any age group
*Any age group  
*Acute, fulminant infection with rapid progression
*Acute, [[fulminant]] life threating complication of prior infection  
*>100.4F fever, with hemodynamic instability  
*>100.4F fever, with [[Hemodynamically unstable|hemodynamic]] instability  
*Life threatening condition
*Worsening [[pneumonia]]-like symptoms
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*CXR demonstrates multiple cavitary lesions
*CXR demonstrates multiple cavitary lesions
*Pleural effusion and empyema are common findings.
*[[Pleural effusion]] and [[empyema]] are common findings
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*CBC is positive for causative organism .
*[[Complete blood count|CBC]] is positive for causative organism
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|-
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*Loculated empyema
*Loculated [[empyema]]
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*Pleuritic chest pain, dry cough, fever with chills
* Children and elderly are at risk
*Dullness to percussion decreased breath sounds, and reduced vocal resonance on examination
 
*Pleuritic [[chest pain]], [[dry cough]], [[fever]] with chills
*Dullness to [[Percussion of the lungs|percussion]] decreased [[breath sounds]], and reduced vocal resonance on examination
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*Empyema appears lenticular in shape and has a thin wall with smooth luminal margins.
*[[Empyema]] appears lenticular in shape and has a thin wall with smooth luminal margins
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*Thoracocentesis
*[[Thoracocentesis]]
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|-
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*Granulomatosis with polyangiitis (Wegener's)<ref name="pmid10377211">{{cite journal |vauthors=Langford CA, Hoffman GS |title=Rare diseases.3: Wegener's granulomatosis |journal=Thorax |volume=54 |issue=7 |pages=629–37 |year=1999 |pmid=10377211 |pmc=1745525 |doi= |url=}}</ref>
*[[Granulomatosis with polyangiitis]] ([[Wegener's granulomatosis|Wegener's]])<ref name="pmid10377211">{{cite journal |vauthors=Langford CA, Hoffman GS |title=Rare diseases.3: Wegener's granulomatosis |journal=Thorax |volume=54 |issue=7 |pages=629–37 |year=1999 |pmid=10377211 |pmc=1745525 |doi= |url=}}</ref>
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*Women are more commonly effected that man.
*Women are more commonly effected than man.<ref name="pmid12541109">{{cite journal |vauthors=Lee KS, Kim TS, Fujimoto K, Moriya H, Watanabe H, Tateishi U, Ashizawa K, Johkoh T, Kim EA, Kwon OJ |title=Thoracic manifestation of Wegener's granulomatosis: CT findings in 30 patients |journal=Eur Radiol |volume=13 |issue=1 |pages=43–51 |year=2003 |pmid=12541109 |doi=10.1007/s00330-002-1422-2 |url=}}</ref>
*Upper respiratory tract: perforation of nasal septum,chronic sinusitis, otitis media,mastoditis.<ref name="pmid12541109">{{cite journal |vauthors=Lee KS, Kim TS, Fujimoto K, Moriya H, Watanabe H, Tateishi U, Ashizawa K, Johkoh T, Kim EA, Kwon OJ |title=Thoracic manifestation of Wegener's granulomatosis: CT findings in 30 patients |journal=Eur Radiol |volume=13 |issue=1 |pages=43–51 |year=2003 |pmid=12541109 |doi=10.1007/s00330-002-1422-2 |url=}}</ref>
*Kidneys are also involved
*Lower respiratory tract: hemoptysis, cough,dyspnea.
*Upper respiratory tract symptoms , perforation of [[nasal septum]], [[chronic sinusitis]], [[otitis media]], [[mastoiditis]].
*Renal: hematuria, red cell casts
*Lower respiratory tract symptoms, [[hemoptysis]], [[cough]], [[dyspnea]].
*Renal symptoms, [[hematuria]], red cell [[casts]]
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*Pulmonary nodules with cavities and infiltrates are a frequent manifestation on CXR.
*Pulmonary nodules with cavities and infiltrates are a frequent manifestation on CXR


|  
|  
*Positive for P-ANCA
*Positive for [[P-ANCA]]
*Biopsy of the tissue involved shows necrotizing granulomas <ref name="pmid10377211">{{cite journal |vauthors=Langford CA, Hoffman GS |title=Rare diseases.3: Wegener's granulomatosis |journal=Thorax |volume=54 |issue=7 |pages=629–37 |year=1999 |pmid=10377211 |pmc=1745525 |doi= |url=}}</ref>
*Biopsy of the tissue involved shows necrotizing [[granulomas]] <ref name="pmid10377211">{{cite journal |vauthors=Langford CA, Hoffman GS |title=Rare diseases.3: Wegener's granulomatosis |journal=Thorax |volume=54 |issue=7 |pages=629–37 |year=1999 |pmid=10377211 |pmc=1745525 |doi= |url=}}</ref>
|-
|-
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*Rheumatoid nodule  
*[[Rheumatoid nodule]]
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*Elderly females of 40-50 age group  
*Elderly females of 40-50 age group  
*Manifestation of rheumatoid arthritis.
*Manifestation of [[rheumatoid arthritis]]
*Presents with other systemic symptoms including symmetric arthritis of the small joints of the hands and feet with morning stiffness are common manifestations.
*Presents with other systemic symptoms including symmetric [[arthritis]] of the small joints of the hands and feet with morning stiffness are common manifestations.
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*Pulmonary nodules with cavitation are located in the upper lobe (Caplan syndrome) on Xray.
*Pulmonary nodules with cavitation are located in the upper lobe ([[Caplan syndrome]]) on Xray.
*Positive for both rheumatoid factor and anticyclic citrullinated peptide antibody
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*Positive for both [[rheumatoid factor]] and anticyclic citrullinated peptide [[Antibody|antibody.]]
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*Sarcoidosis
*[[Sarcoidosis]]
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*More common in African-American females.
*More common in African-American females
*Often asymptomatic except for enlarged lymph nodes.<ref name="pmid11734441">{{cite journal |vauthors=Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager H, Bresnitz EA, DePalo L, Hunninghake G, Iannuzzi MC, Johns CJ, McLennan G, Moller DR, Newman LS, Rabin DL, Rose C, Rybicki B, Weinberger SE, Terrin ML, Knatterud GL, Cherniak R |title=Clinical characteristics of patients in a case control study of sarcoidosis |journal=Am. J. Respir. Crit. Care Med. |volume=164 |issue=10 Pt 1 |pages=1885–9 |year=2001 |pmid=11734441 |doi=10.1164/ajrccm.164.10.2104046 |url=}}</ref>  
*Often [[asymptomatic]] except for [[Lymphadenopathy|enlarged lymph nodes]]<ref name="pmid11734441">{{cite journal |vauthors=Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager H, Bresnitz EA, DePalo L, Hunninghake G, Iannuzzi MC, Johns CJ, McLennan G, Moller DR, Newman LS, Rabin DL, Rose C, Rybicki B, Weinberger SE, Terrin ML, Knatterud GL, Cherniak R |title=Clinical characteristics of patients in a case control study of sarcoidosis |journal=Am. J. Respir. Crit. Care Med. |volume=164 |issue=10 Pt 1 |pages=1885–9 |year=2001 |pmid=11734441 |doi=10.1164/ajrccm.164.10.2104046 |url=}}</ref>  
*Associated with restrictive lung disease (interstitial fibrosis),
*Associated with [[restrictive lung disease]]
*Erythema nodosum,
*[[Erythema nodosum]]
*Lupus pernio (skin lesions on face resembling lupus),
*[[Lupus pernio]] (skin lesions on face resembling lupus)
*Bell palsy,
*[[Bell's palsy|Bell palsy]]
*Epithelioid granulomas containing microscopic Schaumann and asteroid bodies,
*[[Epithelioid]] [[granuloma]]<nowiki/>s containing microscopic [[Schaumann bodies|Schaumann]] and asteroid bodies  
|  
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*On chest Xray bilateral adenopathy and coarse reticular opacities are seen.  
*On CXR bilateral [[Lymphadenopathy|adenopathy]] and coarse reticular opacities are seen.  
*CT of the chest demonstrates extensive hilar and mediastinal adenopathy
*CT of the chest demonstrates extensive [[Hilar lymphadenopathy|hilar]] and mediastinal adenopathy
*Additional findings on CT include fibrosis (honeycomb, linear, or associated with bronchial distortion), pleural thickening, and ground-glass opacities.<ref name="pmid2748828">{{cite journal |vauthors=Brauner MW, Grenier P, Mompoint D, Lenoir S, de Crémoux H |title=Pulmonary sarcoidosis: evaluation with high-resolution CT |journal=Radiology |volume=172 |issue=2 |pages=467–71 |year=1989 |pmid=2748828 |doi=10.1148/radiology.172.2.2748828 |url=}}</ref>
*Additional findings on CT include [[fibrosis]] (honeycomb, linear, or associated with bronchial distortion), pleural thickening, and ground-glass opacities.<ref name="pmid2748828">{{cite journal |vauthors=Brauner MW, Grenier P, Mompoint D, Lenoir S, de Crémoux H |title=Pulmonary sarcoidosis: evaluation with high-resolution CT |journal=Radiology |volume=172 |issue=2 |pages=467–71 |year=1989 |pmid=2748828 |doi=10.1148/radiology.172.2.2748828 |url=}}</ref>
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*Non-caseating granuloma on lung biopsy
*Biopsy of lung shows non-[[caseating]] [[granuloma]]
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*Bronchiolitis obliterans (Cryptogenic organizing pneumonia)<ref name="pmid9724431">{{cite journal |vauthors=Murphy J, Schnyder P, Herold C, Flower C |title=Bronchiolitis obliterans organising pneumonia simulating bronchial carcinoma |journal=Eur Radiol |volume=8 |issue=7 |pages=1165–9 |year=1998 |pmid=9724431 |doi=10.1007/s003300050527 |url=}}</ref><ref name="pmid19561910">{{cite journal |vauthors=Al-Ghanem S, Al-Jahdali H, Bamefleh H, Khan AN |title=Bronchiolitis obliterans organizing pneumonia: pathogenesis, clinical features, imaging and therapy review |journal=Ann Thorac Med |volume=3 |issue=2 |pages=67–75 |year=2008 |pmid=19561910 |pmc=2700454 |doi=10.4103/1817-1737.39641 |url=}}</ref>
*[[Bronchiolitis obliterans]] ([[Cryptogenic organizing pneumonia]])<ref name="pmid9724431">{{cite journal |vauthors=Murphy J, Schnyder P, Herold C, Flower C |title=Bronchiolitis obliterans organising pneumonia simulating bronchial carcinoma |journal=Eur Radiol |volume=8 |issue=7 |pages=1165–9 |year=1998 |pmid=9724431 |doi=10.1007/s003300050527 |url=}}</ref><ref name="pmid19561910">{{cite journal |vauthors=Al-Ghanem S, Al-Jahdali H, Bamefleh H, Khan AN |title=Bronchiolitis obliterans organizing pneumonia: pathogenesis, clinical features, imaging and therapy review |journal=Ann Thorac Med |volume=3 |issue=2 |pages=67–75 |year=2008 |pmid=19561910 |pmc=2700454 |doi=10.4103/1817-1737.39641 |url=}}</ref>
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*Rare condiiton
*Rare condition and mimics [[asthma]], [[pneumonia]] and [[emphysema]]
*It is a pathological diagnosis
*It is caused by [[drug]] or [[toxin]] exposure, [[autoimmune diseases]], [[viral infections]], or [[radiation injury]]
*And is triggered by drug or toxin exposure, autoimmune diseases,viral infections, or radiation injury but is most often idiopathic
*People working in industries are at high risk
*Presents with fever, cough, wheezing and shortness of breath over weeks to months,<ref name="pmid2805873">{{cite journal |vauthors=Cordier JF, Loire R, Brune J |title=Idiopathic bronchiolitis obliterans organizing pneumonia. Definition of characteristic clinical profiles in a series of 16 patients |journal=Chest |volume=96 |issue=5 |pages=999–1004 |year=1989 |pmid=2805873 |doi= |url=}}</ref>
*Presents with [[Fever|feve]]<nowiki/>r, [[cough]], [[wheezing]] and [[shortness of breath]] over weeks to months,<ref name="pmid2805873">{{cite journal |vauthors=Cordier JF, Loire R, Brune J |title=Idiopathic bronchiolitis obliterans organizing pneumonia. Definition of characteristic clinical profiles in a series of 16 patients |journal=Chest |volume=96 |issue=5 |pages=999–1004 |year=1989 |pmid=2805873 |doi= |url=}}</ref>
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*Common appearance on CT is patchy consolidation,often accompanied by ground-glass opacities and nodules.<ref name="pmid8109493">{{cite journal |vauthors=Lee KS, Kullnig P, Hartman TE, Müller NL |title=Cryptogenic organizing pneumonia: CT findings in 43 patients |journal=AJR Am J Roentgenol |volume=162 |issue=3 |pages=543–6 |year=1994 |pmid=8109493 |doi=10.2214/ajr.162.3.8109493 |url=}}</ref>
*Common appearance on CT is patchy [[Consolidation (medicine)|consolidation,]]<nowiki/>often accompanied by ground-glass opacities and nodules.<ref name="pmid8109493">{{cite journal |vauthors=Lee KS, Kullnig P, Hartman TE, Müller NL |title=Cryptogenic organizing pneumonia: CT findings in 43 patients |journal=AJR Am J Roentgenol |volume=162 |issue=3 |pages=543–6 |year=1994 |pmid=8109493 |doi=10.2214/ajr.162.3.8109493 |url=}}</ref>
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*Biopsyof the lung <ref name="pmid19561910">{{cite journal |vauthors=Al-Ghanem S, Al-Jahdali H, Bamefleh H, Khan AN |title=Bronchiolitis obliterans organizing pneumonia: pathogenesis, clinical features, imaging and therapy review |journal=Ann Thorac Med |volume=3 |issue=2 |pages=67–75 |year=2008 |pmid=19561910 |pmc=2700454 |doi=10.4103/1817-1737.39641 |url=}}</ref>
*Biopsy of the lung <ref name="pmid19561910">{{cite journal |vauthors=Al-Ghanem S, Al-Jahdali H, Bamefleh H, Khan AN |title=Bronchiolitis obliterans organizing pneumonia: pathogenesis, clinical features, imaging and therapy review |journal=Ann Thorac Med |volume=3 |issue=2 |pages=67–75 |year=2008 |pmid=19561910 |pmc=2700454 |doi=10.4103/1817-1737.39641 |url=}}</ref>
*Pulmonary function tests demonstarte low fev1/fvc
*[[Pulmonary function tests]] demonstrate low fev1/fvc
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*Langerhan'scell histiocytosis<ref name="pmid22429393">{{cite journal |vauthors=Suri HS, Yi ES, Nowakowski GS, Vassallo R |title=Pulmonary langerhans cell histiocytosis |journal=Orphanet J Rare Dis |volume=7 |issue= |pages=16 |year=2012 |pmid=22429393 |pmc=3342091 |doi=10.1186/1750-1172-7-16 |url=}}</ref>
*[[Langerhans cell histiocytosis|Langerhans]] cell [[Langerhans cell histiocytosis|Histiocytosis]]<ref name="pmid22429393">{{cite journal |vauthors=Suri HS, Yi ES, Nowakowski GS, Vassallo R |title=Pulmonary langerhans cell histiocytosis |journal=Orphanet J Rare Dis |volume=7 |issue= |pages=16 |year=2012 |pmid=22429393 |pmc=3342091 |doi=10.1186/1750-1172-7-16 |url=}}</ref>
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*Exclusively afflicts smokers, with a peak age of onset of between 20 and 40 years.  
*Exclusively afflicts smokers, with a peak age of onset of between 20 and 40 years.  
*Clinical presentation varies, but symptoms generally include months of drycough, fever, night sweats, and weight loss.
*Clinical presentation varies, but symptoms generally include months of dry [[cough]], [[fever]], [[night sweats]] and [[weight loss]].
*Skin is involved in 80% of the cases, scaly erythematous rash is typical.  
*Skin is involved in 80% of the cases, scaly [[erythematous rash]] is typical.  
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*Thin-walled cystic cavities are the usual radiographic manifestation, observed in over 50% of patients by either CXR or CT scans.<ref name="pmid2787035">{{cite journal |vauthors=Moore AD, Godwin JD, Müller NL, Naidich DP, Hammar SP, Buschman DL, Takasugi JE, de Carvalho CR |title=Pulmonary histiocytosis X: comparison of radiographic and CT findings |journal=Radiology |volume=172 |issue=1 |pages=249–54 |year=1989 |pmid=2787035 |doi=10.1148/radiology.172.1.2787035 |url=}}</ref>
*Thin-walled cystic cavities are the usual radiographic manifestation, observed in over 50% of patients by either CXR or CT scans.<ref name="pmid2787035">{{cite journal |vauthors=Moore AD, Godwin JD, Müller NL, Naidich DP, Hammar SP, Buschman DL, Takasugi JE, de Carvalho CR |title=Pulmonary histiocytosis X: comparison of radiographic and CT findings |journal=Radiology |volume=172 |issue=1 |pages=249–54 |year=1989 |pmid=2787035 |doi=10.1148/radiology.172.1.2787035 |url=}}</ref>
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*Biopsy of the lung  
*Biopsy of the lung  
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== Reference ==
== Reference ==
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[[Category:Disease]]
[[Category:Disease]]
[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:Emergency mdicine]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
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Latest revision as of 22:34, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Lung abscess must be differentiated from other lesions that present with similar symptoms such as cough, fever with chills and rigor and chest includes malignancy, pulmonary tuberculosis, Wegener's granulomatosis, rheumatoid nodules.

Differential

Disease Clinical features

Signs & symptoms

Radiological Findings Characterstic feature
Fever Cough Hemoptysis Dyspnea Chest pain Weight loss Night sweats
High-grade Low grade Productive Dry
Acute Lung abscess + + +
  • Air fluid level
Malignancy

(primary lung cancer)

+ + + + +
  • A coin-shaped lesion with thick wall(>15mm) is seen on chest x-ray with less ground glass opacities [2][3
  • Long H/o smoking
  • Elderly male or female
  • BAL positive for malignant cells
  • CT guided biopsy is required for confirmation and differnatiation
Pulmonary Tuberculosis + + + +
  • Chest x-ray and CT demonstrates cavities in the upper lobe of the lung
Necrotizing Pneumonia + + + +
  • Multiple cavitary lesions
  • Acute life threatening condition
  • Complication of pneumonia or lung abscess
  • Multiple organisms responsible
  • prompt treatment with antibiotics is required
  • CBC positive for causative organism
empyema + + + + +
  • Blood culture positive for causative agent.
Bronchiectasis + +
  • Specific findings include linear lucencies tram tracking appearance, clustered cysts.
 High resolution CT helps in diagnosis .
Wegners granulomatosis + + +
  • Seen mostly in female age group of 40-55 years
  • Traid of Upper , lower respiratory tract and kidney disease
  • Biopsy of involved organ confirms granulomas
Sarcoidosis + + + + +
Rheumatoid nodule + +
  • Pulmonary nodules with cavitation are located in the upper lobe are seen on chest x-ray
Langerhans cell Histiocytosis + + +
  • Thin-walled cystic cavities on chest x-ray
  • Exclusively afflicts smokers.
  • Musculoskeletal and skin is involved
  • Biopsy of the involved organ
Bronchiolitis obliterans + + + +
  • Common appearance on CT is patchy consolidation,often accompanied by ground-glass opacities and nodules.
  • Occupational exposure of industrial toxins
  • Restrictive type of lung disease
  • Biopsy often confirms the diagnosis




Causes of

lung cavities

Differentiating Features Differentiating lab findings Diagnosis

confirmation

  • CXR and CT demonstrates cavities in the upper lobe of the lung
  • Sputum smear positive for acid-fast bacilli and nucleic acid amplification tests (NAAT) is used on sputum or any sterile fluid for rapid diagnosis and is positive for mycobacteria.
  • Any age group
  • Acute, fulminant life threating complication of prior infection
  • >100.4F fever, with hemodynamic instability
  • Worsening pneumonia-like symptoms
  • CBC is positive for causative organism
  • Children and elderly are at risk
  • Empyema appears lenticular in shape and has a thin wall with smooth luminal margins
  • Pulmonary nodules with cavities and infiltrates are a frequent manifestation on CXR
  • Elderly females of 40-50 age group
  • Manifestation of rheumatoid arthritis
  • Presents with other systemic symptoms including symmetric arthritis of the small joints of the hands and feet with morning stiffness are common manifestations.
  • Pulmonary nodules with cavitation are located in the upper lobe (Caplan syndrome) on Xray.
  • On CXR bilateral adenopathy and coarse reticular opacities are seen.
  • CT of the chest demonstrates extensive hilar and mediastinal adenopathy
  • Additional findings on CT include fibrosis (honeycomb, linear, or associated with bronchial distortion), pleural thickening, and ground-glass opacities.[7]
  • Common appearance on CT is patchy consolidation,often accompanied by ground-glass opacities and nodules.[11]
  • Exclusively afflicts smokers, with a peak age of onset of between 20 and 40 years.
  • Clinical presentation varies, but symptoms generally include months of dry cough, fever, night sweats and weight loss.
  • Skin is involved in 80% of the cases, scaly erythematous rash is typical.
  • Thin-walled cystic cavities are the usual radiographic manifestation, observed in over 50% of patients by either CXR or CT scans.[13]
  • Biopsy of the lung


Reference

  1. ↑ 1.0 1.1 Chaudhuri MR (1973). "Primary pulmonary cavitating carcinomas". Thorax. 28 (3): 354–66. PMC 470041. PMID 4353362.
  2. ↑ Mouroux J, Padovani B, Elkaïm D, Richelme H (1996). "Should cavitated bronchopulmonary cancers be considered a separate entity?". Ann. Thorac. Surg. 61 (2): 530–2. doi:10.1016/0003-4975(95)00973-6. PMID 8572761.
  3. ↑ Onn A, Choe DH, Herbst RS, Correa AM, Munden RF, Truong MT, Vaporciyan AA, Isobe T, Gilcrease MZ, Marom EM (2005). "Tumor cavitation in stage I non-small cell lung cancer: epidermal growth factor receptor expression and prediction of poor outcome". Radiology. 237 (1): 342–7. doi:10.1148/radiol.2371041650. PMID 16183941.
  4. ↑ 4.0 4.1 Langford CA, Hoffman GS (1999). "Rare diseases.3: Wegener's granulomatosis". Thorax. 54 (7): 629–37. PMC 1745525. PMID 10377211.
  5. ↑ Lee KS, Kim TS, Fujimoto K, Moriya H, Watanabe H, Tateishi U, Ashizawa K, Johkoh T, Kim EA, Kwon OJ (2003). "Thoracic manifestation of Wegener's granulomatosis: CT findings in 30 patients". Eur Radiol. 13 (1): 43–51. doi:10.1007/s00330-002-1422-2. PMID 12541109.
  6. ↑ Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager H, Bresnitz EA, DePalo L, Hunninghake G, Iannuzzi MC, Johns CJ, McLennan G, Moller DR, Newman LS, Rabin DL, Rose C, Rybicki B, Weinberger SE, Terrin ML, Knatterud GL, Cherniak R (2001). "Clinical characteristics of patients in a case control study of sarcoidosis". Am. J. Respir. Crit. Care Med. 164 (10 Pt 1): 1885–9. doi:10.1164/ajrccm.164.10.2104046. PMID 11734441.
  7. ↑ Brauner MW, Grenier P, Mompoint D, Lenoir S, de Crémoux H (1989). "Pulmonary sarcoidosis: evaluation with high-resolution CT". Radiology. 172 (2): 467–71. doi:10.1148/radiology.172.2.2748828. PMID 2748828.
  8. ↑ Murphy J, Schnyder P, Herold C, Flower C (1998). "Bronchiolitis obliterans organising pneumonia simulating bronchial carcinoma". Eur Radiol. 8 (7): 1165–9. doi:10.1007/s003300050527. PMID 9724431.
  9. ↑ 9.0 9.1 Al-Ghanem S, Al-Jahdali H, Bamefleh H, Khan AN (2008). "Bronchiolitis obliterans organizing pneumonia: pathogenesis, clinical features, imaging and therapy review". Ann Thorac Med. 3 (2): 67–75. doi:10.4103/1817-1737.39641. PMC 2700454. PMID 19561910.
  10. ↑ Cordier JF, Loire R, Brune J (1989). "Idiopathic bronchiolitis obliterans organizing pneumonia. Definition of characteristic clinical profiles in a series of 16 patients". Chest. 96 (5): 999–1004. PMID 2805873.
  11. ↑ Lee KS, Kullnig P, Hartman TE, Müller NL (1994). "Cryptogenic organizing pneumonia: CT findings in 43 patients". AJR Am J Roentgenol. 162 (3): 543–6. doi:10.2214/ajr.162.3.8109493. PMID 8109493.
  12. ↑ Suri HS, Yi ES, Nowakowski GS, Vassallo R (2012). "Pulmonary langerhans cell histiocytosis". Orphanet J Rare Dis. 7: 16. doi:10.1186/1750-1172-7-16. PMC 3342091. PMID 22429393.
  13. ↑ Moore AD, Godwin JD, Müller NL, Naidich DP, Hammar SP, Buschman DL, Takasugi JE, de Carvalho CR (1989). "Pulmonary histiocytosis X: comparison of radiographic and CT findings". Radiology. 172 (1): 249–54. doi:10.1148/radiology.172.1.2787035. PMID 2787035.
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