Lung abscess differential diagnosis: Difference between revisions
Jump to navigation
Jump to search
Aditya Ganti (talk | contribs) |
m (Bot: Removing from Primary care) |
||
(22 intermediate revisions by 7 users not shown) | |||
Line 1: | Line 1: | ||
__NOTOC__ | __NOTOC__ | ||
[[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 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]]. | 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 | ==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 | |||
| + | |||
| | |||
| + | |||
| | |||
| | |||
| | |||
| + | |||
| | |||
| | |||
| | |||
* Air fluid level | |||
| | |||
* Foul smelling [[sputum]] | |||
* H/o of prior [[infection]] or [[hospitalization]] | |||
* Associated with risk factors like [[aspiration]] and [[alcoholism]] | |||
|- | |||
|[[Malignancy]] | |||
([[Lung cancer|primary lung cancer]]) | |||
| | |||
| + | |||
| | |||
| + | |||
| + | |||
| | |||
| | |||
| + | |||
| + | |||
| | |||
* 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> | |||
| | |||
* 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]] | |||
| + | |||
| | |||
| + | |||
| | |||
| + | |||
| | |||
| | |||
| | |||
| + | |||
| | |||
* Chest x-ray and CT demonstrates [[Internal|cavities]] in the upper lobe of the [[lung]] | |||
| | |||
* People in [[Endemic (epidemiology)|endemic]] at high risk | |||
* [[Cough]] >2 weeks with [[hemoptysis]] | |||
* [[Acid fast|Acid fast stain]] positive for [[Mycobacterium|mycobacteria]] | |||
|- | |||
|[[Pneumonia|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]] | |||
| + | |||
| | |||
| + | |||
| | |||
| + | |||
| + | |||
| + | |||
| | |||
| | |||
| | |||
* Homogeneous [[Consolidation (medicine)|consolidation]] involving one, or less commonly, multiple [[lobes]] | |||
| | |||
* Blood culture positive for causative agent. | |||
|- | |||
|[[Bronchiectasis]] | |||
| | |||
| | |||
| + | |||
| | |||
| + | |||
| | |||
| | |||
| | |||
| | |||
| | |||
* 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]] | |||
| | |||
| | |||
| + | |||
| | |||
| + | |||
| + | |||
| | |||
| | |||
| | |||
| | |||
* [[Pulmonary]] [[nodules]] with [[cavities]] and infiltrates | |||
| | |||
* 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]] | |||
|- | |||
|[[Sarcoidosis]] | |||
| + | |||
| | |||
| + | |||
| | |||
| + | |||
| | |||
| | |||
| + | |||
| + | |||
| | |||
* [[Bilateral]] [[Lymphadenopathy|adenopathy]] and coarse reticular opacities are seen on CXR | |||
| | |||
* More common in African-american females | |||
* [[Restrictive lung disease]] | |||
** Biposy findings: [[epithelioid]],granuloma<nowiki/>s, schaumann<nowiki/>, asteroid bodies. | |||
|- | |||
|[[Rheumatoid nodule]] | |||
| | |||
| | |||
| | |||
| | |||
| | |||
| + | |||
| | |||
| + | |||
| | |||
| | |||
* [[Pulmonary]] [[nodules]] with cavitation are located in the upper lobe are seen on chest x-ray | |||
| | |||
* [[Rheumatoid arthritis]] | |||
* Positive for [[Rheumatoid factor|RF]] and ACP | |||
|- | |||
|[[Langerhans cell histiocytosis|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 (medicine)|consolidation,]]<nowiki/>often accompanied by ground-glass opacities and nodules. | |||
| | |||
* 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 | ||
Line 38: | Line 253: | ||
*CXR and CT demonstrates [[Internal|cavities]] in the upper lobe of the lung | *CXR and CT demonstrates [[Internal|cavities]] in the upper lobe of the lung | ||
| | | | ||
*[[Sputum]] smear positive for [[acid-fast bacilli]] and nucleic acid amplification tests (NAAT) | *[[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. | ||
|- | |- | ||
| | | | ||
Line 133: | Line 348: | ||
*Biopsy of the lung | *Biopsy of the lung | ||
|} | |} | ||
== Reference == | == Reference == | ||
Line 139: | Line 355: | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Pulmonology]] | [[Category:Pulmonology]] | ||
[[Category:Emergency mdicine]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
Latest revision as of 22:34, 29 July 2020
![](/images/1/16/Home_logo1.png)
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 | + | + | + |
|
| ||||||
Malignancy | + | + | + | + | + |
|
|||||
Pulmonary Tuberculosis | + | + | + | + |
| ||||||
Necrotizing Pneumonia | + | + | + | + |
|
| |||||
empyema | + | + | + | + | + |
|
| ||||
Bronchiectasis | + | + |
|
High resolution CT helps in diagnosis . | |||||||
Wegners granulomatosis | + | + | + |
| |||||||
Sarcoidosis | + | + | + | + | + |
|
| ||||
Rheumatoid nodule | + | + |
| ||||||||
Langerhans cell Histiocytosis | + | + | + |
|
| ||||||
Bronchiolitis obliterans | + | + | + | + |
|
|
Causes of
lung cavities |
Differentiating Features | Differentiating lab findings | Diagnosis
confirmation |
---|---|---|---|
|
|
| |
|
|
|
|
|
|
| |
|
|
|
|
|
|
| |
|
|
| |
|
|
||
|
|
| |
|
|
|
Reference
- ↑ 1.0 1.1 Chaudhuri MR (1973). "Primary pulmonary cavitating carcinomas". Thorax. 28 (3): 354–66. PMC 470041. PMID 4353362.
- ↑ 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.
- ↑ 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.
- ↑ 4.0 4.1 Langford CA, Hoffman GS (1999). "Rare diseases.3: Wegener's granulomatosis". Thorax. 54 (7): 629–37. PMC 1745525. PMID 10377211.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 9.0 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.