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
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Clinical features
Signs & symptoms
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Radiological Findings
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Characterstic feature
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| Fever
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Cough
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Hemoptysis
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Dyspnea
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Chest pain
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Weight loss
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Night sweats
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| High-grade
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Low grade
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Productive
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Dry
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| Acute Lung abscess
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✔
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✔
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- Purulent sputum
- H/o of prior infection or hospitalization
- Associated with risk factors like aspiration and alcoholism
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| Malignancy
(primary lung cancer)
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✔
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✔
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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 CXR with less ground glass opacities [2][3
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- Chronic smoker
- Elderly male or female
- Cough persisting for longer periods
- BAL positive for malignant cells
- CT gold standard
- Biopsy is required for confirmation and differnatiation
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| Pulmonary Tuberculosis
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✔
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✔
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✔
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✔
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- CXR and CT demonstrates cavities in the upper lobe of the lung
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- People in endemic at high risk
- Cough >2 weeks with hemoptysis characterstic
- Acid fast stain positive for mycobacteria
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| Necrotizing Pneumonia
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✔
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✔
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✔
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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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| Pneumonia and empyema
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✔
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✔
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✔
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✔
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✔
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- Homogeneous consolidation involving one, or less commonly, multiple lobes
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- CBC 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 and parallel markings radiating from the hila (tram tracking) dilated bronchi, clustered cysts .
- general findings include increased pulmonary markings, honeycombing, atelectasis and pleural changes.
- CT helps is confirms the diagnosis and is considered gold stadard
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| Wegners granulomatosis
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✔
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✔
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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
- Associated with other auto immune diseases
- Other symptoms such as hematuria is present indicating kidney involvement
- Traid of Upper , lower respiratory tract and kidney disease
- Biopsy of involved organ confirms granulomas
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| Sarcoidosis
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- Bilateral adenopathy and coarse reticular opacities are seen on CXR
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- More common in African-american females
- Associated with other manifestations of restrictive lung disease
- Biposy of the lung shows epithelioid granulomas containing microscopic schaumann and asteroid bodies.
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| Rheumatoid nodule
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- Pulmonary nodules with cavitation are located in the upper lobe are seen on CXR
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- Seen in patients with rheumatoid arthritis
- Positive for Rheumatoid factor and Anticyclic citrullinated peptide
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| Langerhans cell Histiocytosis
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✔
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✔
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- Thin-walled cystic cavities on CXR
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- Exclusively afflicts smokers, with a peak age of onset of between 20 and 40 years.
- Musculoskeletal and skin is involved
- Biopsy of the involved organ
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| Bronchiolitis obliterans
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✔
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✔
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✔
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✔
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- Common appearance on CT is patchy consolidation,often accompanied by ground-glass opacities and nodules.
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- Mimics asthma, pneumonia and emphysema
- Risk is increased with occupational exposure of industrial toxins
- Causes restrictive type of lung disease so FEv1/FVC is >80%
- Biopsy often confirms the diagnosis
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Reference
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