Pneumonia & Lung Abscess

KURSK STATE MEDICAL KURSK STATE MEDICAL UNIVERSITYUNIVERSITYDEPARTMENT OF DEPARTMENT OF

PROPAEDEUTIC OF INNER PROPAEDEUTIC OF INNER DISEASESDISEASES

PNEUMONIA PNEUMONIA LUNG ABSCESSLUNG ABSCESS

Acute pneumoniaAcute pneumoniaDefinitionDefinition

Pneumonia is an acute inflammatory process of infectious origin affecting the pulmonary parenchyma.

Types of pneumoniaTypes of pneumonia

1.1. Community-acquired pneumoniaCommunity-acquired pneumonia2.2. Hospital-acquired (nosocomial) Hospital-acquired (nosocomial)

pneumoniapneumonia3.3. Aspiration pneumoniaAspiration pneumonia4.4. Pneumonia in the Pneumonia in the

immunocompromised host immunocompromised host (including AIDS)(including AIDS)

Types of pneumonia Types of pneumonia Typical pneumoniaTypical pneumonia (usually lobar, pleuropneumonia)(usually lobar, pleuropneumonia) Atypical pneumoniaAtypical pneumonia (usually bronchopneumonia)(usually bronchopneumonia) Primary pneumoniaPrimary pneumonia Secondary pneumoniaSecondary pneumonia

In the diagnosis must be note about In the diagnosis must be note about location of consolidation (side, lobe, segment)location of consolidation (side, lobe, segment)

Morphologic variants of Morphologic variants of pneumoniapneumonia

VariantVariant Causative Causative organismorganism

CharacteristicsCharacteristics

Lobar Lobar Most frequently Most frequently PneumococcusPneumococcus

Predominantly Predominantly intra-alveolar intra-alveolar exudate resulting exudate resulting in consolidation. in consolidation. May involve entire May involve entire lobe.lobe.

Broncho-Broncho-pneumonpneumoniaia

Many organisms Many organisms ((Staph. Aureus, Staph. Aureus, Haemophilus Haemophilus influenza, influenza, Klebsiella, Strep. Klebsiella, Strep. pyogenes)pyogenes)

Acute Acute inflammatory inflammatory infiltrates infiltrates extending from extending from bronchioles into bronchioles into adjacent alveoliadjacent alveoliPatchy distribution Patchy distribution involving one or involving one or more lobes.more lobes.

InterstitiInterstitial al

Most frequently Most frequently viruses or viruses or Mycoplasma pn. Mycoplasma pn. (primary atypical)(primary atypical)

Diffuse patchy Diffuse patchy inflammation inflammation localized to localized to interstitial areas of interstitial areas of alveolar walls. alveolar walls. Involving one or Involving one or ore lobes.ore lobes.

Community – acquired Community – acquired pneumoniapneumonia

This form is This form is responsible for over responsible for over 1000 000 1000 000 admissions per admissions per year.year.

Mortality: 6-20% Mortality: 6-20% Increasingly common Increasingly common with agewith age

Community – acquired Community – acquired pneumonia.pneumonia.

EtiologyEtiologyCommon organisms:Common organisms: Str. Pneumoniae 70% (50-80%)Str. Pneumoniae 70% (50-80%) Chlamidia pneum. 10%Chlamidia pneum. 10% Mycoplasma pneum. 9%Mycoplasma pneum. 9% Legionella pneum. 5%Legionella pneum. 5%Uncommon organisms:Uncommon organisms: Haemophilus influenzae 3%Haemophilus influenzae 3% Staphyl. Aureus <1%Staphyl. Aureus <1% Chlamidia psittaci <1%Chlamidia psittaci <1% Klebsiella pneum. <1%Klebsiella pneum. <1%Primary viral pneumonia:Primary viral pneumonia:Influenza, parainfluenza, measlesInfluenza, parainfluenza, measles

Community – acquired Community – acquired pneumonia.pneumonia.

TransmissionTransmission Aspiration of organisms that Aspiration of organisms that

colonize the oropharynx. colonize the oropharynx. Inhalation of infectious aerosols Inhalation of infectious aerosols

from ambient air.from ambient air. Hematogenous dissemination.Hematogenous dissemination. Direct inoculation from contiguosly Direct inoculation from contiguosly

infected sites.infected sites.

TransmissionTransmission Aspiration is the major route of acquisition Aspiration is the major route of acquisition

for most forms of pneumonia, but very few for most forms of pneumonia, but very few individuals who do aspirate contaminated individuals who do aspirate contaminated oropharyngeal secretion develop oropharyngeal secretion develop pneumonia.pneumonia.

45% of normal people and 70% of 45% of normal people and 70% of obtunded patients aspirate oral secretion, obtunded patients aspirate oral secretion, respiratory tract defenses prevent respiratory tract defenses prevent majority from becoming ill.majority from becoming ill.

Hospital – acquired Hospital – acquired pneumonia (nosocomial)pneumonia (nosocomial)

Refers to a new episode of Refers to a new episode of pneumonia occurring at least 2 pneumonia occurring at least 2 days after admission to the days after admission to the hospital.hospital.

The term includes post-operative The term includes post-operative and certain forms of aspiration and certain forms of aspiration pneumonia.pneumonia.

Hospital – acquired Hospital – acquired pneumoniapneumonia

Predisposing factorsPredisposing factors1. Reduced host defences against 1. Reduced host defences against

bacteria:bacteria: Reduced immune defences Reduced immune defences

(corticosteroid treatment, diabetes, (corticosteroid treatment, diabetes, malignancy).malignancy).

Reduced cough reflex (post-operative).Reduced cough reflex (post-operative). Disordered mucociliary clearance Disordered mucociliary clearance

(anaesthetic agents).(anaesthetic agents). Bulbar or vocal cord palsy.Bulbar or vocal cord palsy.


Predisposing factorsPredisposing factors2. Aspiration of nasopharyngeal or 2. Aspiration of nasopharyngeal or

gastric secretion:gastric secretion: Immobility or reduced conscious Immobility or reduced conscious

level.level. Vomiting, dysphagia, achalasia or Vomiting, dysphagia, achalasia or

severe reflux.severe reflux. Nasogastric intubation.Nasogastric intubation.


Predisposing factorsPredisposing factors3. Bacteria introduced into lower 3. Bacteria introduced into lower respiratory tract:respiratory tract:

Endotracheal intubation / tracheostomy.Endotracheal intubation / tracheostomy. Infected ventilators / nebulisers / Infected ventilators / nebulisers /

bronchoscopes.bronchoscopes. Dental or sinus infection.Dental or sinus infection.4. Bacteraemia:4. Bacteraemia: Abdominal sepsis.Abdominal sepsis. Intravenous cannula infection.Intravenous cannula infection. Infected emboli.Infected emboli.


EtiologyEtiology

The majority of hospital – The majority of hospital – acquired infections are caused by acquired infections are caused by Gram – negative bacteria Gram – negative bacteria (Escherichia, Pseudomonas, (Escherichia, Pseudomonas, Klebsiella).Klebsiella).

Pneumonia in the Pneumonia in the immunocompromised immunocompromised

patientpatientPulmonary infection is common in Pulmonary infection is common in

patients receiving patients receiving immunosuppressive drugs and in immunosuppressive drugs and in those with diseases causing those with diseases causing defects of cellular or humoral defects of cellular or humoral immune mechanisms (Ex.: AIDS).immune mechanisms (Ex.: AIDS).

Lobar pneumoniaLobar pneumoniaHomogeneous consolidation of one ore more Homogeneous consolidation of one ore more lobes, associated with pleural inflammation. lobes, associated with pleural inflammation.

Lobar Lobar Most frequently Most frequently PneumococcusPneumococcus PredominantlPredominantl

y intra-y intra-alveolar alveolar exudate exudate resulting in resulting in consolidationconsolidation. May involve . May involve entire lobe.entire lobe.

Lobar pneumonia Lobar pneumonia Main syndromesMain syndromes

1.1. Inflammation of the lung tissue.Inflammation of the lung tissue.2.2. Consolidation of the lung tissue.Consolidation of the lung tissue.3.3. Intoxication.Intoxication.4.4. General inflammation.General inflammation.5.5. Acute respiratory insufficiency.Acute respiratory insufficiency.6.6. Heart failure.Heart failure.7.7. Affection of the other organs. Affection of the other organs.

Lobar pneumoniaLobar pneumoniaMorphologyMorphology

4 stages:4 stages:1.1. CongestionCongestion2.2. Red hepatizationRed hepatization3.3. Grey hepatizationGrey hepatization4.4. ResolutionResolution

Lobar pneumoniaLobar pneumoniaMorphology Morphology

CONGESTION1) Hyperemia of the lung tissue.2) Exudation.3) Obstruction of capillary patency.4) Stasis of the blood.

It lasts from 12 hours to 3 days


RED HEPATIZATION1) Massive confluent

exudation with red cells and neutrophils and fibrin filling the alveolar spaces.

2) The lobe now appears distinctly red, firm, and airless with a liver like consistency.

Continues from 1 to 3 days.


GRAY HEPATIZATION1) Progressive disintegration

of red cells.2) The alveoli (containing

fibrin) become filled with leucocytes

3) Persistence of fibrosuppurative exudates, giving the gross appearance of a grayish brown, dry surface.

Lasts from 2 to 6 days.


RESOLUTION The consolidated exudate within

the alveolar spaces undergoes progressive enzymic digestion to produce a granular, semifluid debris that is resorbed, ingested by macrophages, or coughed up.

Lobar pneumoniaLobar pneumoniaClinical stagesClinical stages

1. Onset of the disease 1. Onset of the disease (1(1stst morphological stage)morphological stage)

2. Height of the disease 2. Height of the disease (2(2ndnd and 3 and 3rdrd morphological stages ) morphological stages )3. Resolution 3. Resolution (4(4thth morphological stage) morphological stage)

Clinical symptoms Clinical symptoms I stageI stage (onset of the (onset of the

disease)disease)Complaints: Complaints: Shaking chills (persist for 1-3 hours) or rigor Shaking chills (persist for 1-3 hours) or rigor

(imply bacteraemia).(imply bacteraemia). Fever (39- 40Fever (39- 4000C) C) Pleuritic pain in the chest (on the affected side) Pleuritic pain in the chest (on the affected side)

– – in lower lobe pneumonia can simulate acute in lower lobe pneumonia can simulate acute appendicitis, hepatic colics.appendicitis, hepatic colics.

Dyspnoea. Dyspnoea. Cough is first dry Cough is first dry (in 1-2 days rusty sputum is (in 1-2 days rusty sputum is

expectorated – in the beginning of red hepatization expectorated – in the beginning of red hepatization stage).stage).

Severe headache (in atypical pneumonia).Severe headache (in atypical pneumonia). Pain in the body & limbs.Pain in the body & limbs.

Clinical symptoms Clinical symptoms I stageI stage

General inspection: General condition is grave .General condition is grave . Confusion (hallucinations & Confusion (hallucinations &

delirium, delirium, especially in alcoholic patients). especially in alcoholic patients). ConvulsionsConvulsions (may be in children) (may be in children)

““Facies pneumonica: Facies pneumonica: Hyperemia of the cheeks, more Hyperemia of the cheeks, more

pronounced on the affected pronounced on the affected side, participation of the side, participation of the nostrils in breathing, herpes nostrils in breathing, herpes nasalis & labialis.nasalis & labialis.

General cyanosisGeneral cyanosis

Clinical symptoms Clinical symptoms I stageI stage

Respiratory system Respiratory system examinationexamination

Lagging of the affected Lagging of the affected side.side.

Dyspnoea.Dyspnoea. Vocal fremitus is Vocal fremitus is

increased.increased. Dulled-tympanic Dulled-tympanic

percussion sound.percussion sound. Auscultation – diminished Auscultation – diminished

vesicular breathing, vesicular breathing, crepitation “indux”,crepitation “indux”, increased bronchophonyincreased bronchophony

Clinical symptoms Clinical symptoms II stage (height of the disease)II stage (height of the disease)

General inspection data – the same as in I General inspection data – the same as in I stage.stage.

Lagging of the affected sideLagging of the affected side Tachypnoea (30-40 per min).Tachypnoea (30-40 per min). Vocal fremitus increased.Vocal fremitus increased. Dull percussion sound.Dull percussion sound. Bronchial breathing, pleural friction rub.Bronchial breathing, pleural friction rub. Bronchophony increased, egophony (“ee” as Bronchophony increased, egophony (“ee” as

“ay”), whispered pectoriloquy. “ay”), whispered pectoriloquy. Cardiovascular symptoms: tachycardia, may Cardiovascular symptoms: tachycardia, may

be vascular collapse (vascular failure, BP be vascular collapse (vascular failure, BP drop – due to toxicosis).drop – due to toxicosis).

Clinical symptoms Clinical symptoms III stage (resolution)III stage (resolution)

Cough with mucopurulent sputum.Cough with mucopurulent sputum. Dyspnoea decreases.Dyspnoea decreases. Vocal fremitus increased. Vocal fremitus increased. Dullness decreases. Dulled – Dullness decreases. Dulled –

tympanic sound.tympanic sound. Bronchial breathing gradually Bronchial breathing gradually

disappears. Crepitation “redux”. disappears. Crepitation “redux”. Moist rales.Moist rales.

Investigations Investigations Blood test Blood test

A high neutrophil leucocytosis A high neutrophil leucocytosis (bacterial pneumonia).(bacterial pneumonia).

Marginally raised or normal white Marginally raised or normal white cell count (atypical agents).cell count (atypical agents).

A marked leucopenia – in viral A marked leucopenia – in viral etiology.etiology.

Increased ESR.Increased ESR.

Investigations Investigations Blood testBlood test

Blood gasesBlood gases – to determine oxygen – to determine oxygen therapy.therapy.

Blood culture.Blood culture. Biochemical test:Biochemical test: Hyponatraemia (typical for Legionella).Hyponatraemia (typical for Legionella). Liver function test (often abnormal in Liver function test (often abnormal in

atypical atypical pneumonia).pneumonia). Serum urea >7 mmol/L (predictive of Serum urea >7 mmol/L (predictive of

high mortality). high mortality).

Investigations Investigations SputumSputum

11stst stage (congestion): stage (congestion): may be present small may be present small amount - tenacious; slightly crimson, contains amount - tenacious; slightly crimson, contains much protein, a small number of leucocytes, much protein, a small number of leucocytes, erythrocytes, alveolar cells and macrophages.erythrocytes, alveolar cells and macrophages.

22ndnd stage (red hepatization): stage (red hepatization): scant and rusty; it scant and rusty; it contains fibrin and higher number of formed contains fibrin and higher number of formed elements.elements.

33rdrd stage (gray hepatization): stage (gray hepatization): leukocyte count leukocyte count increases significantly; mucopurulent sputum.increases significantly; mucopurulent sputum.

44thth stage (resolution): stage (resolution): leukocytes are converted leukocytes are converted into detritus into detritus

Microbiological Microbiological investigations investigations

Sputum:Sputum: Direct smear by Direct smear by

Gram.Gram. Culture.Culture. Antimicrobial Antimicrobial

sensitivity test.sensitivity test.

Microbiological Microbiological investigationsinvestigations

Serology:Serology: Acute and convalescent titers (Mycoplasma,

Chlamidia, Legionella and viral infections). Pneumococcal Ag in sputum, serum & urine. Direct fluorescent Ab stain in Legionella. Legionella Ag in urine. Cold agglutinins – positive in 50% of

patients with Mycoplasma.

Investigations Investigations X-rayX-ray

Homogeneous Homogeneous opacity opacity localized to the localized to the affected lobeaffected lobe

Complications: Complications: 1. pulmonary 1. pulmonary 2. 2.

extrapulmonaryextrapulmonary Para- or metapneumonic effusionPara- or metapneumonic effusion EmpyemaEmpyema Retention of sputum causing lobar collapseRetention of sputum causing lobar collapse Pneumothorax (particularly with Staph. Pneumothorax (particularly with Staph.

aureus)aureus) Lung abscessLung abscess Septicaemia Septicaemia Cirrhosis of the affected lung (carnification)Cirrhosis of the affected lung (carnification) Renal failure, multi-organ failureRenal failure, multi-organ failure Adult respiratory distress syndrome Adult respiratory distress syndrome Ectopic abscess formationEctopic abscess formation Hepatitis, nephritis, pericarditis, Hepatitis, nephritis, pericarditis,

myocarditis, meningoencephalitis myocarditis, meningoencephalitis

BronchopneumoniaBronchopneumonia (focal pneumonia) (focal pneumonia)

More patchy alveolar consolidation More patchy alveolar consolidation associated with bronchial and associated with bronchial and bronchiolar inflammationbronchiolar inflammation

It occurs most commonly in infancy, It occurs most commonly in infancy, in aged patients especially with long-in aged patients especially with long-standing and severe diseases standing and severe diseases (cancer, uremia, stroke)(cancer, uremia, stroke)

Main syndromes in Main syndromes in bronchopneumoniabronchopneumonia

1.1. Focal consolidation.Focal consolidation.2.2. Respiratory insufficiency.Respiratory insufficiency.3.3. Intoxication.Intoxication.

Bronchopneumonia Bronchopneumonia Clinical symptomsClinical symptoms

The onset is usually overlooked The onset is usually overlooked because it often develops against the because it often develops against the background of bronchitis or catarrh background of bronchitis or catarrh of the upper airways (secondary).of the upper airways (secondary).

The findings of physical examination The findings of physical examination at the onset are the same as in acute at the onset are the same as in acute bronchitis.bronchitis.


CoughCough Fever different: remittent, irregular Fever different: remittent, irregular

(usually subfebrile).(usually subfebrile). Temperature may be Temperature may be normal at aged patients.normal at aged patients.

DyspnoeaDyspnoea Pain in the chest (only in involvement Pain in the chest (only in involvement

of the pleura in peripheral located of the pleura in peripheral located inflammatory focus) inflammatory focus)


Moderate hyperemia of the face; cyanosis Moderate hyperemia of the face; cyanosis of the lips.of the lips.

Tachypnoea (25-30 per min).Tachypnoea (25-30 per min).

Palpation, percussion and auscultation Palpation, percussion and auscultation may be not effective (if the foci are small may be not effective (if the foci are small and deeply located).and deeply located).


In presence of large focus,In presence of large focus,if it is located peripherallyif it is located peripherally(over the limited part of the (over the limited part of the

chest):chest): vocal fremitus – increasedvocal fremitus – increased dull percussion sounddull percussion sound vesiculobronchial or vesiculobronchial or bronchial breathing, bronchial breathing, dry / consonating moist dry / consonating moist

rales, rales, crepitationcrepitation

Bronchopneumonia Bronchopneumonia InvestigationsInvestigations

Blood test: Blood test: mild leucocytosis, mild leucocytosis, moderately increased ESR.moderately increased ESR.

Sputum:Sputum: mucopurulent; great mucopurulent; great number of leucocytes, macrophages number of leucocytes, macrophages and columnar epithelium. Bacterial and columnar epithelium. Bacterial flora is varied.flora is varied.

X-ray:X-ray: focal consolidations at least 1- focal consolidations at least 1-2 cm in diameter2 cm in diameter

Treatment of pneumoniaTreatment of pneumonia Food should be rich in vitamins and Food should be rich in vitamins and

easily assimilable.easily assimilable. Antibiotics.Antibiotics. Sulpha drugs.Sulpha drugs. Oxygen therapy.Oxygen therapy. Expectorants.Expectorants.

Criteria for hospitalization Criteria for hospitalization of patients with pneumonia: of patients with pneumonia:

the PORT score the PORT score (Pneumonia (Pneumonia Patient Outcomes Research Team )Patient Outcomes Research Team )

Risk classRisk class No. of pointsNo. of points RecommendatioRecommendations for site of ns for site of carecare

II No predictorsNo predictors Outpatient Outpatient IIII < 70< 70 OutpatientOutpatientIIIIII 71 – 9071 – 90 InpatientInpatientIVIV 91 – 13091 – 130 InpatientInpatient

VV >130>130 InpatientInpatient

Criteria for hospitalization Criteria for hospitalization of patients with pneumoniaof patients with pneumonia

Demographic factorDemographic factor

Characteristic Characteristic Points Points MenMen Age (years)Age (years)

Women Women Age (years) - 10 Age (years) - 10

Nursing home Nursing home residentresident

+ 10+ 10


Coexisting illnessesCoexisting illnesses

Characteristic Characteristic Points Points

Neoplastic diseaseNeoplastic disease +30+30

Liver diseaseLiver disease +30+30

Heart failureHeart failure +10+10

Cerebrovascular diseaseCerebrovascular disease +10+10

Renal diseaseRenal disease +10+10


Physical examination findingsPhysical examination findings

Characteristic Characteristic Points Points

Altered mental statusAltered mental status +20+20

Resp. rate >30/minResp. rate >30/min +20+20

SBP<90 mm HgSBP<90 mm Hg +20+20

Temp. <35Temp. <3500 or>40 or>4000CC +15+15

Pulse > 125/minPulse > 125/min +10+10


Laboratory & radiographic Laboratory & radiographic findingsfindings

Characteristic Characteristic Points Points Arterial pH < 7,35Arterial pH < 7,35 +30+30Blood urea nitrogen > 30 mg/dLBlood urea nitrogen > 30 mg/dL +20+20Sodium < 130 mmol/LSodium < 130 mmol/L +20+20Glucose > 250 mg/dL (14 mmol/L)Glucose > 250 mg/dL (14 mmol/L) +10+10Hematocrit < 30%Hematocrit < 30% +10+10OO22 saturation < 90% saturation < 90% +10+10Pleural effusionPleural effusion +10+10

Pulmonary abscessPulmonary abscessIs a purulent melting of the lung Is a purulent melting of the lung

tissue circumscribed by an tissue circumscribed by an inflammatory swellinginflammatory swelling

It develops mostly as an outcome of It develops mostly as an outcome of pneumonia or complicated pneumonia or complicated bronchoiectasis. bronchoiectasis.

Pulmonary abscessPulmonary abscessEtiology Etiology

StreptococciStreptococci StaphylococciStaphylococci PneumococciPneumococci

Pulmonary abscessPulmonary abscessClinical symptomsClinical symptoms

2 periods are distinguished:2 periods are distinguished:11stst – before opening an abscess – before opening an abscess

(formation of abscess; it continues (formation of abscess; it continues 10-12 days)10-12 days)

22ndnd – after opening an abscess (begins – after opening an abscess (begins with the opening of the purulent with the opening of the purulent abscess into the bronchus)abscess into the bronchus)

Pulmonary abscessPulmonary abscessI periodI period

Complaints:Complaints: WeaknessWeakness ChillsChills Cough with meager sputumCough with meager sputum Pain in the chest (in pleura Pain in the chest (in pleura

involvement)involvement) DyspnoeaDyspnoea Fever (remittent or hectic)Fever (remittent or hectic)


In peripheral location of abscessIn peripheral location of abscess Palpation of the chest: pain (when the Palpation of the chest: pain (when the

costal pleura is involved)costal pleura is involved) Unilateral thoracic laggingUnilateral thoracic lagging Vocal fremitus – increased Vocal fremitus – increased Percussion: dull soundPercussion: dull sound Auscultation: diminished vesicular or Auscultation: diminished vesicular or

bronchialbronchial breathing, smt. harsh with dry ralesbreathing, smt. harsh with dry rales

In deep abscess (or small size) results of In deep abscess (or small size) results of objective examination are not changedobjective examination are not changed


InvestigationsInvestigations

Blood test: Blood test: neutrophylic leucocytosis; shift to neutrophylic leucocytosis; shift to the left, the left,

to the myelocytes; ESR increased significantlyto the myelocytes; ESR increased significantly Sputum:Sputum: not specific not specific X-ray:X-ray: does not differ from pneumonia or does not differ from pneumonia or

tuberculosis infiltration: a large focus of tuberculosis infiltration: a large focus of increased density with rough and indistinct increased density with rough and indistinct marginsmargins

Pulmonary abscessPulmonary abscessII periodII periodComplaints:Complaints:

Severe cough with sudden release of Severe cough with sudden release of ample offensive purulent sputum (“full ample offensive purulent sputum (“full mouth”):mouth”):

on standing separates into three layers: on standing separates into three layers: mucous, serous and purulent mucous, serous and purulent (from 200 ml to 1-2 L/day)(from 200 ml to 1-2 L/day) DyspnoeaDyspnoea Pain in the chestPain in the chest

Pulmonary abscessPulmonary abscessII periodII period

Clinical symptomsClinical symptoms Unilateral thoracic Unilateral thoracic

lagginglagging Vocal fremitus – Vocal fremitus –

increasedincreased Percussion: tympanic / Percussion: tympanic /

metallic sound; metallic sound; crackled - pot soundcrackled - pot sound

Auscultation: bronchial Auscultation: bronchial (amphoric / cavernous) (amphoric / cavernous) breathing; breathing;

resonant moist rales;resonant moist rales; gutta cadens (falling – gutta cadens (falling –

drop sound)drop sound)


Investigations:Investigations:Blood test: Blood test: Neutrophylic leucocytosis.Neutrophylic leucocytosis. Shift to the left, Shift to the left, to the myelocytes.to the myelocytes. ESR increased significantly.ESR increased significantly.Sputum:Sputum: On standing separates into On standing separates into

three layers: mucous, serous three layers: mucous, serous and purulent.and purulent.

Elastic fibers.Elastic fibers. Leucocytes and Leucocytes and

erythrocytes. erythrocytes. Dittrich’s plugs (resemble Dittrich’s plugs (resemble

the lenticular formations the lenticular formations with offensive odour on with offensive odour on pressing )pressing )


X-ray:X-ray: cavity with liquid cavity with liquid

levellevel

Pulmonary abscessPulmonary abscessTreatmentTreatment

HospitalizationHospitalization Adequate drainingAdequate draining Antibiotics Antibiotics Desintoxication Desintoxication

Pneumonia & Lung Abscess

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