Lung abscess differential diagnosis: Difference between revisions

Jump to navigation Jump to search
← Older editNewer edit →
VisualWikitext
Aditya Ganti (talk | contribs)
Bureaucrats, bureaucrats, nocaptcha, Administrators
11,402 edits
Aditya Ganti (talk | contribs)
Bureaucrats, bureaucrats, nocaptcha, Administrators
11,402 edits
Line 98: Line 98:
*Epithelioid granulomas containing microscopic Schaumann and asteroid bodies,  
*Epithelioid granulomas containing microscopic Schaumann and asteroid bodies,  
|  
|  
*On chest Xray bilateral adenopathy and coarse reticular opacities are seen.  
*On CXR bilateral adenopathy and coarse reticular opacities are seen.  
*CT of the chest demonstrates extensive hilar and mediastinal adenopathy
*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.<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>
Line 107: Line 107:
*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>
|
|
*Rare condiiton
*Rare condiiton.
*It is a pathological diagnosis
*It is a pathological diagnosis and mimics asthma,pneumonia and emphysema.
*And is triggered by drug or toxin exposure, autoimmune diseases,viral infections, or radiation injury but is most often idiopathic
*It is triggered by drug or toxin exposure, autoimmune diseases,viral infections, or radiation injury.
*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, 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>
|
|

Revision as of 20:27, 6 February 2017

Abscess Main Page

Lung abscess Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Lung abscess from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Lung abscess differential diagnosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Lung abscess differential diagnosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Lung abscess differential diagnosis

CDC on Lung abscess differential diagnosis

Lung abscess differential diagnosis in the news

Blogs on Lung abscess differential diagnosis

Directions to Hospitals Treating Lung abscess

Risk calculators and risk factors for Lung abscess differential diagnosis

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 cause cough, fever with chills and rigor and chest pain such as malignancy, tuberculosis, Wegener's granulomatosis, rheumatoid nodules

Differential diagnosis

Causes of

lung cavities

Differentiating Features Differentiating lab findings Diagnosis

confirmation

  • Malignancy (Primary lung cancer)[1]
  • Elderly male or female [1]
  • 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 X-ray with less ground glass opacities.[2] [3]
  • Bronchoalveolar lavage cytology shows malignant cells
  • Biopsy of lung
  • Tuberculosis
  • Any age group
  • Symptoms include productive cough,night sweats ,fever and weight loss.
  • CXR and CT demonstrates cavities in the upper lobe of the lung.
  • Sputum smear positive for acid-fast bacilli and culture in Lowenstein-Jensen media grows mycobacteria.
  • Necrotizing Pneumonia
  • Any age group
  • Acute, fulminant infection with rapid progression
  • >100.4F fever, with hemodynamic instability
  • Life threatening condition
  • CXR demonstrates multiple cavitary lesions
  • Pleural effusion and empyema are common findings.
  • CBC is positive for causative organism .
  • Loculated empyema
  • Pleuritic chest pain, dry cough, fever with chills
  • Dullness to 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)[4]
  • Women are more commonly effected that man.
  • Upper respiratory tract: perforation of nasal septum,chronic sinusitis, otitis media,mastoditis.[5]
  • Lower respiratory tract: hemoptysis, cough,dyspnea.
  • Renal: hematuria, red cell casts
  • Pulmonary nodules with cavities and infiltrates are a frequent manifestation on CXR.
  • Positive for P-ANCA
  • Biopsy of the tissue involved shows necrotizing granulomas [4]
  • 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 Xray.
  • Positive for both rheumatoid factor and anticyclic citrullinated peptide antibody
  • Sarcoidosis
  • More common in African-American females.
  • Often asymptomatic except for enlarged lymph nodes.[6]
  • Associated with restrictive lung disease (interstitial fibrosis),
  • Erythema nodosum,
  • Lupus pernio (skin lesions on face resembling lupus),
  • Bell palsy,
  • Epithelioid granulomas containing microscopic Schaumann and asteroid bodies,
  • 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]
  • Non-caseating granuloma on lung biopsy
  • Bronchiolitis obliterans (Cryptogenic organizing pneumonia)[8][9]
  • Rare condiiton.
  • It is a pathological diagnosis and mimics asthma,pneumonia and emphysema.
  • It is triggered by drug or toxin exposure, autoimmune diseases,viral infections, or radiation injury.
  • Presents with fever, cough, wheezing and shortness of breath over weeks to months,[10]
  • Common appearance on CT is patchy consolidation,often accompanied by ground-glass opacities and nodules.[11]
  • Biopsyof the lung [9]
  • Pulmonary function tests demonstarte low fev1/fvc
  • Langerhan'scell Histiocytosis[12]
  • 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.
  • 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.


Template:WikiDoc Sources

Retrieved from "https://www.wikidoc.org/index.php?title=Lung_abscess_differential_diagnosis&oldid=1289925"