Diagnosis of Lung abscess | symptoms, signs and investigations

An Approach to diagnosis of lung abscess
This is a guide on how to diagnose a case of lung abscess.
Clinical picture

I- Pneumonic stage

- Fever , Headache , Anorexia , Malaise .
- Pleurisy ---> chest pain.
- Cough - dyspnea
- Signs of consolidation ( diminished chest movement , increased TVF , dullness , bronchial breathing , coarse consonating crepitations , bronchophony whispering )

II- Stage of acute abscess

 (After about 1-2 weeks)
lung abscessIt is manifested with fever, toxaemia then the patient gets a severe attack of cough with expectoration of thick mucus plug followed by large foited sputum due to growth of anaerobes. This is usually followed by drop of fever & improvement of general condition .

Signs : - Diminished movement.
           - TVF high -Dullness
           - Bronchial breathing - Bronchophony - whispering
           - Coarse consonating crepitations .
           - Post tussive suction

III- Stage of chronic abscess
chronic Lung abscess

Symptoms
* Toxemia (fever - anorexia -loss of weight-sweating)
* Symptoms of cavitary or suppurative lung with retension syndrome .
Signs:
• General : Toxemia - clubbing of fingers
• Local : signs of cavity + fibrosis
- Normal shape of the chest or retraction (fibrosis)
- Increased TVF  (cavity), the mediastinum may be shifted to the same side (fibrosis)
- Dullness
- Bronchial breathing, bronchophony with coarse consonating crepitations (cavity).

Investigations:
• X-ray : cavity with fluid level
• Culture & Sensitivity. (for aerobes & anaerobes)
• CT scan chest
• Bronchoscopy is indicated when an abscess does not resolve completely with antibiotic therapy to exclude malignancy or foreign body.

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