II. Definition
- Localized lung cavity filled with pus
- Product of lung necrosis
- Cavity is often surrounded by infection
III. Causes
- See Pneumonia Causes
- Anaerobic flora
- Staphylococcus aureus
- Mycobacterium tuberculosis
- Nontuberculous Mycobacteria
- Fungal infection
IV. Symptoms
- Fever
- Chills
- Night Sweats
- Productive cough of foul Sputum
- Dyspnea
- Fatigue
- Weight loss
- Pleuritic Chest Pain
- Hemoptysis
V. Signs
- Localized dullness over involved lung
- Bronchial breath sounds or absent breath sounds
- Fingernail Clubbing
VI. Differential Diagnosis
VII. Imaging: Chest XRay
- Solitary cavitary lesion with air-fluid level
- Lesion surrounded by pneumonitis
VIII. Labs
-
Sputum examination
- Microscopy
- Gram Stain
- Mycobacterial stains
- Fungal stains
- Sputum layers on standing
- Sputum Cultures are usually not helpful
- Microscopy
- Complete Blood Count
IX. Diagnosis
- Bronchoscopy if proximal obstructing tumor is suspected
X. Management: Antibiotics
- Initial IV Dose
- Penicillin 10-12 MU IV for 1 dose
- Subsequent IV Doses
- Penicillin V 750-1000 mg IV qid or
- Clindamycin 600 mg q8h IV
- Subsequent home dosing
- Clindamycin 300 mg PO qid for 6 weeks
