Lung abscess differential diagnosis: Difference between revisions

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*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>
*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>
*Presents with a low-grade fever, absence of [[leukocytosis]], systemic complaints [[weight loss]], [[fatigue]]
*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  
*Absence of factors that predispose to [[gastric content aspiration]], no response to [[antibiotics]] within 10 days  
*[[Hemoptysis]] is commonly associated with [[bronchogenic carcinoma]]
*[[Hemoptysis]] is commonly associated with [[bronchogenic carcinoma]]
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*A coin-shaped lesion with thick wall(>15mm) is seen on X-ray 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>
*A coin-shaped lesion with thick wall(>15mm) is seen on X-ray 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  
*[[Bronchoalveolar lavage]] [[cytology]] shows malignant cells  
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*Biopsy of lung  
*[[Biopsy]] of lung  
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*Pulmonary Tuberculosis  
*Pulmonary [[Tuberculosis, pulmonary|Tuberculosis]]
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*Any age group
*Mostly in endemic areas
*Symptoms include productive cough,night sweats ,fever and weight loss
*Symptoms include [[productive cough]],[[night sweats]], [[fever]] and [[weight loss]]
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*CXR and CT demonstrates cavities in the upper lobe of the lung
*CXR and CT demonstrates [[Internal|cavities]] in the upper lobe of the lung
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*Sputum smear positive for acid-fast bacilli and culture in Lowenstein-Jensen media grows mycobacteria
*[[Sputum]] smear positive for [[acid-fast bacilli]] and culture in Lowenstein-Jensen media grows [[mycobacteria]]
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*Necrotizing Pneumonia
*[[Necrotizing Pulmonary Infections|Necrotizing]] [[Pneumonia]]
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*Any age group
*Any age group  
*Acute, fulminant life threating infection  
*Acute, [[fulminant]] life threating complication of prior infection  
*>100.4F fever, with hemodynamic instability  
*>100.4F fever, with [[Hemodynamically unstable|hemodynamic]] instability  
*Worsening pneumonia like symtoms  
*Worsening [[pneumonia]] like symtoms  
   
   
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*CXR demonstrates multiple cavitary lesions
*CXR demonstrates multiple cavitary lesions
*Pleural effusion and empyema are common findings
*[[Pleural effusion]] and [[empyema]] are common findings
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*CBC is positive for causative organism   
*[[Complete blood count|CBC]] is positive for causative organism   
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*Loculated empyema
*Loculated [[empyema]]
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*Pleuritic chest pain, dry cough, fever with chills
* Children and elderly are at risk
*Dullness to percussion decreased breath sounds, and reduced vocal resonance on examination
 
*Pleuritic [[chest pain]], [[dry cough]], [[fever]] with chills
*Dullness to [[Percussion of the lungs|percussion]] decreased [[breath sounds]], and reduced vocal resonance on examination
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*Empyema appears lenticular in shape and has a thin wall with smooth luminal margins
*[[Empyema]] appears lenticular in shape and has a thin wall with smooth luminal margins
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*Thoracocentesis
*[[Thoracocentesis]]
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*Granulomatosis with polyangiitis (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>
*[[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>
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*Women are more commonly effected that man.
*Women are more commonly effected that man.

Revision as of 21:05, 7 February 2017

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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 diagnosis

Causes of

lung cavities

Differentiating Features Differentiating lab findings Diagnosis

confirmation

  • CXR and CT demonstrates cavities in the upper lobe of the lung
  • Any age group
  • Acute, fulminant life threating complication of prior infection
  • >100.4F fever, with hemodynamic instability
  • Worsening pneumonia like symtoms
  • 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
  • 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]
  • Biopsy of lung shows non-caseating granuloma
  • Bronchiolitis obliterans (Cryptogenic organizing pneumonia)[8][9]
  • 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, 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 demonstrate 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.


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