Necrotizing pulmonary infections: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
 
(One intermediate revision by the same user not shown)
Line 101: Line 101:




==Differential Diagnosis==
Necrotizing lung infections must be differentiated from other cavitary lung lesions.


{| class="wikitable"
!Causes of
lung cavities
!Differentiating Features
!Differentiating radiological findings
!Diagnosis
confirmation
|-
|
*[[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>
|
*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>
*Chronic smokers
*Presents with a [[low-grade fever]], absence of [[leukocytosis]], systemic complaints [[weight loss]], [[fatigue]]
*Absence of factors that predispose to [[gastric content aspiration]], no response to [[antibiotics]] within 10 days
*[[Hemoptysis]] is commonly associated with [[bronchogenic carcinoma]]
|
*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
|
*[[Biopsy]] of lung
|-
|
*Pulmonary [[Tuberculosis, pulmonary|Tuberculosis]]
|
*Mostly in endemic areas
*Symptoms include [[productive cough]], [[night sweats]], [[fever]], and [[weight loss]]
|
*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) is used on sputum or any sterile fluid for rapid diagnosis and is positive for mycobacteria.
|-
|
*[[Necrotizing Pulmonary Infections|Necrotizing]] [[Pneumonia]]
|
*Any age group
*Acute, [[fulminant]] life threating complication of prior infection
*>100.4 °F fever, with [[Hemodynamically unstable|hemodynamic]] instability
*Worsening [[pneumonia]]-like symptoms
|
*CXR demonstrates multiple cavitary lesions
*[[Pleural effusion]] and [[empyema]] are common findings
|
*[[Complete blood count|CBC]] is positive for causative organism 
|-
|
*Loculated [[empyema]]
|
* Children and elderly are at risk


{{WikiDoc Help Menu}}
*Pleuritic [[chest pain]], [[dry cough]], [[fever]] with chills
{{WikiDoc Sources}}
*Dullness to [[Percussion of the lungs|percussion]] decreased [[breath sounds]], and reduced vocal resonance on examination
|
*[[Empyema]] appears lenticular in shape and has a thin wall with smooth luminal margins
|
*[[Thoracocentesis]]
|-
|
*[[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>
|
*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>
*Kidneys are also involved
*Upper respiratory tract symptoms, perforation of [[nasal septum]], [[chronic sinusitis]], [[otitis media]], [[mastoiditis]].
*Lower respiratory tract symptoms (e.g. [[hemoptysis]], [[cough]], [[dyspnea]])
*Renal symptoms, [[hematuria]], red cell [[casts]]
|
*Pulmonary nodules with cavities and infiltrates are a frequent manifestation on CXR


[[Category:Disease]]
|
[[Category:Pulmonology]]
*Positive for [[P-ANCA]]
[[Category:Intensive care medicine]]
*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>
|-
|
*[[Rheumatoid nodule]]
|
*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 X-ray
|
*Positive for both [[rheumatoid factor]] and anticyclic citrullinated peptide [[Antibody|antibody.]]
|-
|
*[[Sarcoidosis]]
|
*More common in African-American females
*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]]
*[[Erythema nodosum]]
*[[Lupus pernio]] (skin lesions on face resembling lupus)
*[[Bell's palsy|Bell palsy]]
*[[Epithelioid]] [[granuloma]]<nowiki/>s containing microscopic [[Schaumann bodies|Schaumann]] and asteroid bodies
|
*On CXR bilateral [[Lymphadenopathy|adenopathy]] and coarse reticular opacities are seen
*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>
|
*Biopsy of lung shows non-[[caseating]] [[granuloma]]
|-
|
*[[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>
|
*Rare condition and mimics [[asthma]], [[pneumonia]] and [[emphysema]]
*It is caused by [[drug]] or [[toxin]] exposure, [[autoimmune diseases]], [[viral infections]], or [[radiation injury]]
*People working in industries are at high risk
*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>
|
*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>
|
*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]] demonstrate low fev1/fvc
|-
|
*[[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>
|
*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.<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>
|
*Biopsy of the lung
|}
 
==References==
{{Reflist|2}}

Latest revision as of 23:56, 21 September 2017

Necrotizing pulmonary infections

WikiDoc Resources for Necrotizing pulmonary infections

Articles

Most recent articles on Necrotizing pulmonary infections

Most cited articles on Necrotizing pulmonary infections

Review articles on Necrotizing pulmonary infections

Articles on Necrotizing pulmonary infections in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Necrotizing pulmonary infections

Images of Necrotizing pulmonary infections

Photos of Necrotizing pulmonary infections

Podcasts & MP3s on Necrotizing pulmonary infections

Videos on Necrotizing pulmonary infections

Evidence Based Medicine

Cochrane Collaboration on Necrotizing pulmonary infections

Bandolier on Necrotizing pulmonary infections

TRIP on Necrotizing pulmonary infections

Clinical Trials

Ongoing Trials on Necrotizing pulmonary infections at Clinical Trials.gov

Trial results on Necrotizing pulmonary infections

Clinical Trials on Necrotizing pulmonary infections at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Necrotizing pulmonary infections

NICE Guidance on Necrotizing pulmonary infections

NHS PRODIGY Guidance

FDA on Necrotizing pulmonary infections

CDC on Necrotizing pulmonary infections

Books

Books on Necrotizing pulmonary infections

News

Necrotizing pulmonary infections in the news

Be alerted to news on Necrotizing pulmonary infections

News trends on Necrotizing pulmonary infections

Commentary

Blogs on Necrotizing pulmonary infections

Definitions

Definitions of Necrotizing pulmonary infections

Patient Resources / Community

Patient resources on Necrotizing pulmonary infections

Discussion groups on Necrotizing pulmonary infections

Patient Handouts on Necrotizing pulmonary infections

Directions to Hospitals Treating Necrotizing pulmonary infections

Risk calculators and risk factors for Necrotizing pulmonary infections

Healthcare Provider Resources

Symptoms of Necrotizing pulmonary infections

Causes & Risk Factors for Necrotizing pulmonary infections

Diagnostic studies for Necrotizing pulmonary infections

Treatment of Necrotizing pulmonary infections

Continuing Medical Education (CME)

CME Programs on Necrotizing pulmonary infections

International

Necrotizing pulmonary infections en Espanol

Necrotizing pulmonary infections en Francais

Business

Necrotizing pulmonary infections in the Marketplace

Patents on Necrotizing pulmonary infections

Experimental / Informatics

List of terms related to Necrotizing pulmonary infections

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

List of Causes of Necrotizing Pulmonary Infections

  • Traumas
  • Pulmonary contusion
  • Infectious Disorders (Specific Agent)
  • Infected organ & Abscesses
  • Granulomatous, Inflammatory Disorders
  • Neoplastic Disorders
  • Carcinoma lung squamous cell/large cell
  • Metastatic lung disease
  • Metastatic lung lymphatics/carcinoma
  • Pulmonary lymphoma
  • Arteriosclerotic Vascular Disorders
  • Poisoning (Specific Agent)
  • Anthracosilicosis
  • Silicosis
  • Silicotuberculosis


Differential Diagnosis

Necrotizing lung infections must be differentiated from other cavitary lung lesions.

Causes of

lung cavities

Differentiating Features Differentiating radiological 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
  • >100.4 °F 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 X-ray
  • 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

References

  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.
Retrieved from "https://www.wikidoc.org/index.php?title=Necrotizing_pulmonary_infections&oldid=1365092"