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Abses paru

Norhidayah

DEFINISI
Cavitary lung lesions produced by infectious
agents
They may be consequences of aspiration
(most commonly) or pneumonia or they
may be secondary to bronchial obstruction,
bronchiectasis, bacterial endocarditis or
spread of infection from elsewhere in the
lung

ETIOLOGI
Anaerobes are most frequent cause; most lung abscesses are polymicrobial in etiology
Peptostreptococcus
Bacteroides
Fusobacterium
Also
Staphylococcus
Streptococcus pyogenes
Klebsiella
Haemophilus influenzae
Actinomyces species
And, rarely
Aspergillus
Cryptococcus
Histoplasma
Blastomyces
Coccidioides
Mycobacterium

Predisposisi
Most abscesses are caused by mouth
anaerobes in patients with pre-existing
periodontal disease
Alcoholics (most commonly), those with
seizure disorders leading to aspiration and
those with poor dentition are at a higher
risk

Patofisiologi

Terjadi melalui dua cara:


Aspirasi
Hematogen.

Paling sering akibat aspirasi, stasis


sekresi, benda asing, tumor, dan striktur
bronkial.
Sering terjadi pd pasien bronkhitis kronik
byk mukus pd saluran napas bawah
media pertumbuhan bakteri.

Secara hematogen:
akibat septikemia atau fenomena septik embolik,
sekunder dari fokus infeksi dari bagian tubuh lain,
spt tricuspid valve endocarditis.
Abses yg terbentuk multipel.
Penyebab tersering stafilokokus.
Penanganannya lebih sulit.
Ukuran abses bervariasi dr bbrpa mm sampai
>5 cm.

Manifestasi klinis
Typically take 7-14 days from pneumonia to
abscess formation, depending on agent
Fever
Cough
Foul-smelling sputum production
Hemoptysis
Night sweats
Anorexia and weight loss

DD
Cavitary bronchogenic carcinoma
TB
Multiple cavities point toward a necrotizing
pneumonia more than lung abscess
Multiple cavitating masses point towards
septic emboli

Gambaran radiologi

Usually single cavity


Cavities typically have a
Thick-wall (which may become thinner as the
surrounding inflammation resolves)
Smooth inner margin
Air-fluid level
More frequent in superior segments of lower lobes or
posterior segments of lower lobes
Unlike pleural collections, lung abscesses frequently
have a fluid level which is approximately the same
length on both the frontal and lateral projection
About 1/3 may have an associated empyema

Terapi
Antibiotics for 4-6 weeks or until the chest
radiograph shows resolution
Percutaneous catheter drainage
Surgery, either a lobectomy or
pneumonectomy, may be used for patients
who fail to respond to medical therapy

Komplikasi
Empyema
Bronchopleural fistula
Fibrosis of pleura

Prognosis
With proper antibiotic treatment, over 90%
are cured
Those who are immunocompromised or
have a bronchial obstruction have a high
mortality rate

TERIMA KASIH