http://204.29.171.80/framer/navigation.asp?charset=utf-8&cc=US&frameid=1565&lc=en- us&providerid=262&realname=Googel&uid=3641541&url=http%3A%2F%2Fwww.google.com %2F AUTHOR I NFORMATION Authored b y Mark Zwanger, MD, MBA, Program Director, Assistant Professor, Department ofSurgery, Division of Emergency Medicine, Thomas Jefferson University Coauthored by Patti Purpura, MD, Consulting Staff, Departme nt of Emerge ncy Medicine, Virginia Mason Hospital Mark Zwanger, MD, MBA, is a member of the following medical societies: American Co llege ofEmergen cy PhysiciansEdited by Mark S Slabinski, MD, Director, Department of Emergency Medicine, Southeastern Ohio Regional Medical Center; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Paul Blackburn, DO, Program Director, Department of Emergency Medicine, Maricopa Medical Center; Assistant Professor, Department of Surgery, University of Arizona; John Halamka, MD, ChiefInformation Officer, CareGroup Healthcare System, Assistant Professor of Medicine, Department ofEmergency Medicine, Beth Israel Deaconess Medical Center; Assistant Professor of Medicine, Harvard Medical School; and Robert O'Connor, MD, MPH, Program Director, Associate Professor, Thomas Jefferson University, Program Director, Department of Emergency Medicine, Christiana Care Health System Editor's Email: Mark S Slabinski, MD eMedicine Journal , April 24 2002, Volume 3, Number4 INTRODUCTION Background: A lung ab scess is a subac ute infection i n which an ar ea of necr osis forms in th e lung parenchyma. It usually is in a dependent section of the lung, more often involves the right lung than the left, and is most commonly seen after aspiration of oropharyngeal secretions. Lung abscesses have a slow, insidious presentation and usually develop 1-2 weeks after the initial aspiration event. Empyema is defined as pus in the pleural space. It typically is a complication of pneumonia. However, it can also arise from penetrating chest trauma, esophageal rupture, or inoculation of the pleural cavity after thoracentesis or chest tube placement. An empyema can also occur from extension of a subdiaphragmatic or paravertebral abscess. Pathophysiology: Lung abscesses involve the lung parenchyma, while empyema involves the pleural space. Mortality/Morbidity: The mortality rate for lung abscesses is approximately 4-7% but varies with the type of material aspirated. Aspiration of fluids with mixed gram-negative flora has a mortality rate approaching 20%, while aspiration of acidic materials has an even higher rate. Age: These conditions occur more commonly in the elderly. CLINICAL History: The patient's history may reveal the following findings: • Many patients give a history of a recent diagnosis and treatment for pneumonia. • A recent hist ory of pene trating ches t trauma sh ould raise cli nical suspicion for empyema. • Patients report a cough productive of bloody sputum that frequently has a fetid odor oroffensive appearance. • Fever• Shortness of breath • Anorexia, w eight loss • Night sweats • Pleuritic chest pain Physical: The physical examination may reveal the following findings: • Temperature frequently elevated but usually not greater than 102°F • Tachypnea • Rales • Rhonchi • Egophony • Tubular breath sounds
