II. Definition

  1. Localized lung cavity filled with pus
  2. Product of lung necrosis
  3. Cavity is often surrounded by infection

III. Causes

  1. See Pneumonia Causes
  2. Anaerobic flora
  3. Staphylococcus aureus
  4. Mycobacterium tuberculosis
  5. Nontuberculous Mycobacteria
  6. Fungal infection

IV. Symptoms

  1. Fever
  2. Chills
  3. Night Sweats
  4. Productive cough of foul Sputum
  5. Dyspnea
  6. Fatigue
  7. Weight loss
  8. Pleuritic Chest Pain
  9. Hemoptysis

V. Signs

  1. Localized dullness over involved lung
  2. Bronchial breath sounds or absent breath sounds
  3. Fingernail Clubbing

VII. Imaging: Chest XRay

  1. Solitary cavitary lesion with air-fluid level
  2. Lesion surrounded by pneumonitis

VIII. Labs

  1. Sputum examination
    1. Microscopy
      1. Gram Stain
      2. Mycobacterial stains
      3. Fungal stains
    2. Sputum layers on standing
    3. Sputum Cultures are usually not helpful
  2. Complete Blood Count
    1. Leukocytosis

IX. Diagnosis

  1. Bronchoscopy if proximal obstructing tumor is suspected

X. Management: Antibiotics

  1. Initial IV Dose
    1. Penicillin 10-12 MU IV for 1 dose
  2. Subsequent IV Doses
    1. Penicillin V 750-1000 mg IV qid or
    2. Clindamycin 600 mg q8h IV
  3. Subsequent home dosing
    1. Clindamycin 300 mg PO qid for 6 weeks

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