Pulmonary Abscess in Children

1. Pulmonary Abscess in Children
Dr.Padmesh. V

2. Lung infection
Destroys lung parenchyma
Cavitations and central necrosis
Localized areas of thick-walled purulent material
Lung abscess

3. • Primary lung abscess:
• Occur in previously healthy patients with no
underlying medical disorders.
• Usually solitary.
• Secondary lung abscess:
• Occur in patients with underlying or predisposing
conditions
• May be multiple.

4. • PATHOLOGY AND PATHOGENESIS
• Predisposing conditions:
• Aspiration (of infected material or FB)
• Pneumonia / Hematogenous seeding from other sites
• Cystic fibrosis
• Gastroesophageal reflux
• Tracheoesophageal fistula
• Immunodeficiencies
• Postoperative complications of tonsillectomy and
adenoidectomy
• Seizures
• Neurologic and other conditions associated with
impaired mucociliary defense.

5. • PATHOLOGY AND PATHOGENESIS:
Aspiration of infected material or foreign body
Pneumonitis impairs drainage of fluid or aspirated
material
Inflammatory vascular obstruction
Tissue necrosis, liquefaction
Abscess formation

6. • PATHOLOGY AND PATHOGENESIS
Aspiration in recumbent position
Right & Left upper lobes and apical segment of the
right lower lobes most likely.
Aspiration in upright position
Posterior segments of upper lobes most likely

7. • PATHOLOGY AND PATHOGENESIS
• Primary abscesses: Most often on Right side.
• Secondary lung abscesses, esp in
immunocompromised : Predilection for left side.

8. • Organisms: Both anaerobic and aerobic organisms.
• Anaerobic bacteria:
• Bacteroides spp.,
• Fusobacterium spp.,
• Peptostreptococcus spp.,
• Aerobic bacteria:
• Streptococcus spp.,
• Staphylococcus aureus
• Escherichia coli
• Klebsiella pneumoniae
• Pseudomonas aeruginosa
• Mycoplasma pneumoniae (Very rare)
• Fungi can cause lung abscess,esp in immunocompromised.

9. • CLINICAL MANIFESTATIONS: Symptoms
• Cough,
• Fever,
• Dyspnea,
• Chest pain,
• Vomiting,
• Sputum production,
• Weight loss,
• Hemoptysis.

10. • CLINICAL MANIFESTATIONS: Signs
• Tachypnea
• Dyspnea
• Retractions with accessory muscle use
• Decreased breath sounds
• Dullness to percussion in affected area
• Crackles
• Occasionally a prolonged expiratory phase on
auscultation

11. • Diagnosis:
• Chest X Ray: Parenchymal inflammation with a
cavity containing an air–fluid level .

12. • Diagnosis:
• Chest CT scan:
Abscess is usually a thick-walled lesion with a
low-density center progressing to an air–fluid level.

13. • Diagnosis:
• Gram stain of sputum: Early clue.
• Sputum cultures: Yield mixed bacteria, therefore
not always reliable.
• Attempts to avoid contamination from oral flora include direct lung
puncture, percutaneous (aided by CT guidance) or transtracheal
aspiration, and bronchoalveolar lavage specimens obtained
bronchoscopically.

14. • Diagnosis:
• Bronchoscopic aspiration should be avoided as it
can be complicated by massive intrabronchial
aspiration.
• To avoid invasive procedures in previously normal
hosts, empiric therapy can be initiated in the
absence of culturable material.

15. • Differential Diagnosis:
• Abscesses should be distinguished from pneumatoceles.
• Pneumatoceles often complicate severe bacterial
pneumonias.
• Pneumatoceles: Thin- and Smooth-walled, localized air
collections with or without air–fluid level.
• Pneumatoceles often resolve spontaneously with
treatment of specific cause of the pneumonia.

16. • TREATMENT:
• Conservative management.
• 2-3 wk course of parenteral antibiotics for
uncomplicated cases, followed by oral antibiotics to
complete a Total of 4-6 wk.
• Aerobic and anaerobic coverage.
• Include penicillinase-resistant agent active against S.aureus
and anaerobic coverage, typically clindamycin or
ticarcillin/clavulanic acid.
• If Gram-negative bacteria are suspected or isolated, an
aminoglycoside should be added.

17. • TREATMENT
• Early CT-guided percutaneous aspiration or drainage.
• Severely ill or those who fail to improve after 7-10 days of
antibiotics  Surgical intervention.
• Minimally invasive CT guided percutaneous aspiration.
• Thorascopic drainage.
• In rare complicated cases  Thoracotomy with surgical
drainage or lobectomy and/or decortication.

18. • PROGNOSIS
• Excellent.
• Presence of aerobic organisms may be a negative
prognostic indicator, particularly in those with
secondary lung abscesses.
• Most become asymptomatic within 7-10 days,
although fever can persist for as long as 3 wk.
• Radiologic abnormalities usually resolve in 1-3 mo
but can persist for years.

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