Lung abscess differential diagnosis

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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

Disease	Clinical features Signs & symptoms									Radiological Findings	Characterstic feature
	Fever		Cough		Hemoptysis	Dyspnea	Chest pain	Weight loss	Night sweats
	High-grade	Low grade	Productive	Dry
Acute Lung abscess	✔		✔				✔			Air fluid level	Foul smelling sputum H/o of prior infection or hospitalization Associated with risk factors like aspiration and alcoholism
Malignancy (primary lung cancer)		✔		✔	✔			✔	✔	A coin-shaped lesion with thick wall(>15mm) is seen on CXR with less ground glass opacities [2][3	Long H/o smoking Elderly male or female BAL positive for malignant cells CT guided biopsy is required for confirmation and differnatiation
Pulmonary Tuberculosis	✔		✔		✔				✔	CXR and CT demonstrates cavities in the upper lobe of the lung	People in endemic at high risk Cough >2 weeks with hemoptysis Acid fast stain positive for mycobacteria
Necrotizing Pneumonia	✔		✔		✔		✔			Multiple cavitary lesions	Acute life threatening condition Complication of pneumonia or lung abscess Multiple organisms responsible prompt treatment with antibiotics is required CBC positive for causative organism
Pneumonia and empyema	✔		✔		✔	✔	✔			Homogeneous consolidation involving one, or less commonly, multiple lobes	Blood culture positive for causative agent.
Bronchiectasis			✔		✔					Specific findings include linear lucencies tram tracking appearance, clustered cysts. increased pulmonary markings, honeycombing, atelectasis and pleural changes.	High resolution CT helps in diagnosis .
Wegners granulomatosis			✔		✔	✔				Pulmonary nodules with cavities and infiltrates	Seen mostly in Female age group of 40-55 years Traid of Upper , lower respiratory tract and kidney disease Biopsy of involved organ confirms granulomas
Sarcoidosis	✔		✔		✔			✔	✔	Bilateral adenopathy and coarse reticular opacities are seen on CXR	More common in African-american females Restrictive lung disease Biposy findings epithelioid granulomas schaumannasteroid bodies.
Rheumatoid nodule						✔		✔		Pulmonary nodules with cavitation are located in the upper lobe are seen on CXR	Rheumatoid arthritis Positive for RF and ACP
Langerhans cell Histiocytosis						✔	✔	✔		Thin-walled cystic cavities on CXR	Exclusively afflicts smokers. Musculoskeletal and skin is involved Biopsy of the involved organ
Bronchiolitis obliterans			✔		✔	✔	✔			Common appearance on CT is patchy consolidation,often accompanied by ground-glass opacities and nodules.	Occupational exposure of industrial toxins Restrictive type of lung disease Biopsy often confirms the diagnosis

Reference

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