EM · Aspiration pneumonia & lung abscess
Aspiration pneumonia and lung abscess
Also known as Aspiration pneumonitis · Anaerobic pneumonia · Lung abscess · Aspiration syndrome
Aspiration pneumonia and lung abscess — the two-hit mechanism (the chemical pneumonitis from the acid and the bacterial infection from the oropharyngeal flora), the risk factors (the reduced consciousness, the dysphagia, the alcohol, the seizure, the stroke), the organisms (the anaerobes and the mixed aerobes), the presentation (the fever, the foul-smelling sputum, the cavitation), the management (the clindamycin or the co-amoxiclav covering the anaerobes, the 2-to-4-week course, the drainage for the large abscess), and the treatment of the underlying cause. ACEM-primary, globally tagged.
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Meet the patient
A 58-year-old alcoholic with poor dentition and chronic dysphagia arrives with three weeks of fevers, drenching night sweats, an 8-kg weight loss and copious foul-smelling purulent sputum. The contrast CT shows a 5.5 cm cavity with a thick wall and an air-fluid level in the posterior segment of the right upper lobe.[1]
The smell is the clue the textbook cannot teach by text. The foul sputum signals the anaerobes, the dependent location signals the aspiration, and the cavity signals the abscess that needs weeks, not days, of antibiotics. Two questions decide the disposition: is this pneumonitis or pneumonia? (the smell and the course say infection) and does the cavity need draining? (the size and the response decide).[1]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Emergency Medicine fellowship atlas.
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- [1]Lim WS, Baudouin SV, George RC, et al. BTS guidelines for the management of community acquired pneumonia in adults: update 2009 Thorax, 2009.PMID 19783532
- [2]Marra A, Hillejan L, Ukena D [Management of Lung Abscess] Zentralbl Chir, 2015.PMID 26351764
- [3]Marik PE Aspiration pneumonitis and aspiration pneumonia N Engl J Med, 2001.PMID 11228282
- [4]Marik PE Aspiration pneumonia: mixing apples with oranges and tangerines Crit Care Med, 2004.PMID 15190985
- [5]DiBardino DM, Wunderink RG Aspiration pneumonia: a review of modern trends J Crit Care, 2015.PMID 25129577
- [6]Kuhajda I, Zarogoulidis K, Tsirgogianni K, Tsavlis D, et al. Lung abscess-etiology, diagnostic and treatment options Ann Transl Med, 2015.PMID 26366400
- [7]Sperling S, Dahl VN, Fløe A Lung abscess: an update on the current knowledge and call for future investigations Curr Opin Pulm Med, 2024.PMID 38411181
- [8]Lee JH, Hong H, Tamburrini M, Park CM Percutaneous transthoracic catheter drainage for lung abscess: a systematic review and meta-analysis Eur Radiol, 2022.PMID 34327579
- [9]Raghavendran K, Nemzek J, Napolitano LM, Knight PR Aspiration-induced lung injury Crit Care Med, 2011.PMID 21263315
- [10]Levison ME, Mangura CT, Lorber B, et al. Clindamycin compared with penicillin for the treatment of anaerobic lung abscess Ann Intern Med, 1983.PMID 6838068
- [11]Yoshimatsu Y, Aga M, Komiya K, et al. The clinical significance of anaerobic coverage in the antibiotic treatment of aspiration pneumonia: a systematic review and meta-analysis J Clin Med, 2023.PMID 36902779
- [12]Gillet-Vittori L, Afanetti M, Dupont A, Gondon E, Dupont D Life-threatening Panton-Valentine leukocidin-associated staphylococcal infections in children. A broad spectrum of clinical presentations Arch Pediatr, 2014.PMID 25284731