Lung abscess differential diagnosis: Difference between revisions

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! colspan="9" |Clinical features
! colspan="9" |Clinical features
Signs & symptoms
Signs & symptoms
! rowspan="3" |Radiological Findings
! rowspan="3" |Characterstic feature  
! rowspan="3" |Characterstic feature  
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* Air fluid level
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* Purulent sputum
* Purulent sputum
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* A coin-shaped lesion with thick wall(>15mm) is seen on CXR with less ground glass opacities <sup>[[Lung abscess differential diagnosis|[2][3]]</sup>
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* Chronic smoker  
* Chronic smoker  
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* CXR and CT demonstrates [[Internal|cavities]] in the upper lobe of the lung
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* People in endemic at high risk
* People in endemic at high risk
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* multiple cavitary lesions
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* Acute life threatening condition  
* Acute life threatening condition  
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* homogeneous consolidation involving one, or less commonly, multiple lobes
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* CBC positive for causative agent.
* CBC positive for causative agent.
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* Specific findings include linear lucencies and parallel markings radiating from the hila (tram tracking) dilated bronchi, clustered cysts .
* general findings include increased pulmonary markings, honeycombing, atelectasis and pleural changes.
* CT helps is confirms the diagnosis and is considered gold stadard
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* Pulmonary nodules with cavities and infiltrates
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* Seen mostly in Female age group of 40-55 years
* Seen mostly in Female age group of 40-55 years
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* Bilateral [[Lymphadenopathy|adenopathy]] and coarse reticular opacities are seen on CXR
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* More common in African-american females
* More common in African-american females
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* Pulmonary nodules with cavitation are located in the upper lobe are seen on CXR
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* Seen in patients with rheumatoid arthritis
* Seen in patients with rheumatoid arthritis
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* Thin-walled cystic cavities on CXR
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* Exclusively afflicts smokers, with a peak age of onset of between 20 and 40 years.
* Exclusively afflicts smokers, with a peak age of onset of between 20 and 40 years.
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* Common appearance on CT is patchy [[Consolidation (medicine)|consolidation,]]<nowiki/>often accompanied by ground-glass opacities and nodules.
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* Mimics [[asthma]], [[pneumonia]] and [[emphysema]]
* Mimics [[asthma]], [[pneumonia]] and [[emphysema]]

Revision as of 20:17, 8 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
  • 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
  • >100.4F 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 Xray.
  • 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


Disease Clinical features

Signs & symptoms

Characterstic feature
Fever Cough Hemoptysis Dyspnea Chest pain Weight loss Night sweats
High-grade Low grade Productive Dry
Acute Lung abscess ✔ ✔ ✔
  • Purulent sputum
  • H/o of prior infection or hospitalization
  • Associated with risk factors like aspiration and alcoholism
Malignancy

(primary lung cancer)

✔ ✔ ✔ ✔ ✔
  • Chronic smoker
  • Elderly male or female
  • Cough persisting for longer periods
  • BAL positive for malignant cells
  • CT gold standard
  • Biopsy is required for confirmation and differnatiation
Pulmonary Tuberculosis ✔ ✔ ✔ ✔
  • People in endemic at high risk
  • Cough >2 weeks with hemoptysis characterstic
  • Acid fast stain positive for mycobacteria
Necrotizing Pneumonia ✔ ✔ ✔ ✔
  • 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 ✔ ✔ ✔ ✔ ✔
  • CBC positive for causative agent.
Bronchiectasis ✔ ✔
Wegners granulomatosis ✔ ✔ ✔
  • Seen mostly in Female age group of 40-55 years
  • Associated with other auto immune diseases
  • Other symptoms such as hematuria is present indicating kidney involvement
  • Traid of Upper , lower respiratory tract and kidney disease
  • Biopsy of involved organ confirms granulomas
Sarcoidosis ✔ ✔ ✔ ✔ ✔
  • More common in African-american females
  • Associated with other manifestations of restrictive lung disease
  • Biposy of the lung shows epithelioid granulomas containing microscopic schaumann and asteroid bodies.
Rheumatoid nodule ✔ ✔
  • Seen in patients with rheumatoid arthritis
  • Positive for Rheumatoid factor and Anticyclic citrullinated peptide
Langerhans cell Histiocytosis ✔ ✔ ✔
  • Exclusively afflicts smokers, with a peak age of onset of between 20 and 40 years.
  • Musculoskeletal and skin is involved
  • Biopsy of the involved organ
Bronchiolitis obliterans ✔ ✔ ✔ ✔
  • Mimics asthma, pneumonia and emphysema
  • Risk is increased with occupational exposure of industrial toxins
  • Causes restrictive type of lung disease so FEv1/FVC is >80%
  • Biopsy often confirms the diagnosis

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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