Suppurative Lung Disease
Suppurative Lung Disease
Suppurative Lung Disease
Definition
Abnormal and permanent
dilatation of bronchi
Bronchiectasis
Focal
Airways supplying a limited region of
pulmonary parenchyma
Diffuse
More widespread distribution
Affects older individuals
2/3 women
Pathology
Destructive and inflammatory changes
Inflammation
Neutrophils (elastase and matrix metalloproteinases)
Dilated airways
Pools of thick, purulent material
Peripherally occluded by secretions
Obliterated and replaced by fibrous tissue
Pathology
Microscopic
Bronchial and peribronchial inflammation and fibrosis
Wall ulceration
Squamous metaplasia
Mucous gland hyperplasia.
Parenchyma-fibrosis, emphysema,atelectasis
↑vascularity of the bronchial wall
Pathology
Patterns
Cylindrical
Uniformly dilated and end abruptly
Varicose
Irregular or beaded resemble varicose veins.
Saccular (cystic)
Ballooned appearance at the periphery, ending in blind sacs
Etiology and Pathogenesis
Inflammation and destruction of the structural
components
Infection -Inflammation
Vicious cycle
Inflammation → airway damage → impaired clearance
of microrganisms → further infection → inflammation
Infectious Causes
Adenovirus and influenza virus
B.pertussis, in childhood
Cigarette smoking
Clinical Manifestations
Persistent /recurrent cough and purulent sputum
P/E finding :
Crackles, rhonchi, and wheezes , clubbing
Clubbing of fingers
Site, extent
High cost
DIAGNOSIS
Sputum -↑ neutrophils or organisms
CBC
Urinalysis
PFT- Diffuse bronchiectasis or associated
COPD
Workup should be dictated by a careful
assessment of the clinical scenario
Bronchiectasis: Treatment
Major goals:
Treatment of infection, particularly in acute
exacerbations
Improved clearance of tracheobronchial secretions
Reduction of inflammation
Treatment of an identifiable underlying problem
Treatment
Bronchodilators
Treatment
Surgery-Replaced by more effective antibiotic and
supportive therapy
Indication
Localized and the morbidity is substantial despite
adequate medical therapy
Massive hemoptysis
Resection - localized,
Microbiology
Anaerobic bacteria most common
CT of the chest
Size and location /additional cavities/ presence of pleural dx
Surgical indications
Refractory hemoptysis
Inadequate response to medical therapy
Need for a tissue diagnosis(noninfectious)
EMPYEMA
Definition
Pus collection in the pleural cavity
EMPYEMA
The pathogenesis
Shared presentations-
CXR
U/S -loculated
PF analysis-exudative
Low pH,glucose,↑LDH,↑protein
CT
Treatment
Antimicrobial treatment
Identification and treatment of any anatomic processes
Drainage of the infected fluid
Based on the clinical status and microbiology
Gram’s stain predominant organism
Fastidious (S. pneumoniae, anaerobes) may be seen on
Gram’s stain but not isolated in culture
Antibiotic susceptibility guide therapy